Preemptive Versus Postoperative Analgesia in Colorectal Surgery: A Systematic Review and Meta-Analysis

Area of Science:

• Anesthesiology and Pain Management
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Preemptive analgesia aims to reduce pain by blocking nociceptive input before surgical stimuli.
• It holds potential for improving postoperative recovery in patients undergoing colorectal surgery.
• This study evaluates preemptive versus postoperative analgesia efficacy and safety in this patient group.

Purpose of the Study:

• To assess the effectiveness of preemptive analgesia compared to postoperative analgesia.
• To determine the impact on pain scores, opioid consumption, and recovery outcomes.
• To evaluate the safety profile of preemptive analgesia in colorectal surgery.

Main Methods:

• Systematic search of major databases (PubMed, Scopus, Web of Science, Cochrane Library) up to May 2025.
• Inclusion of randomized controlled trials (RCTs) comparing preemptive and postoperative analgesia in adult colorectal surgery patients.
• Primary outcomes: 24-hour opioid consumption and VAS pain scores at 24/48 hours; secondary outcomes: adverse events, hospital stay, PONV.

Main Results:

• Seven RCTs with 625 patients (312 preemptive, 313 postoperative) were included.
• Preemptive analgesia showed a significant reduction in VAS pain scores at 24 hours (MD -0.45, p=0.04).
• No significant differences were found in VAS scores at 48 hours or 24-hour opioid consumption between groups.

Conclusions:

• Preemptive analgesia did not reduce 24-hour opioid consumption in colorectal surgery patients.
• It effectively decreased VAS pain scores at 24 hours postoperatively.
• No significant differences were observed in long-term pain, hospital stay, or adverse events, including PONV.