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[Prevention of postoperative pain]
1Département d'anesthésie-réanimation, hôpital Bicêtre, France.
Annales Francaises D'Anesthesie Et De Reanimation
|September 29, 1998
Summary
Pre-emptive analgesia, or administering pain relief before surgery, shows limited benefits. While common for local anesthetics and opioids, evidence for non-steroidal anti-inflammatory drugs (NSAIDs) and ketamine is inconclusive or limited.
Area of Science:
- Anesthesiology
- Pain Management
- Pharmacology
Context:
- The concept of pre-emptive analgesia suggests that administering pain relief before a painful stimulus can enhance its effectiveness.
- This review critically evaluates existing literature based on established methodological criteria.
Purpose:
- To assess the efficacy of pre-emptive analgesia across various analgesic classes and administration routes.
- To determine the clinical significance and research potential of pre-emptive analgesic strategies.
Summary:
- Local anesthetic techniques (infiltration, nerve blocks) generally do not provide pre-emptive analgesia.
- Opioid efficacy is contradictory, and pre-operative oral non-steroidal anti-inflammatory drugs (NSAIDs) offer no benefit.
- Intravenous NSAIDs show limited advantage but increase bleeding; ketamine (NMDA antagonist) shows potential but requires further research.
Impact:
- Current anesthesiology practice often employs pre-emptive administration of local anesthetics and opioids, despite limited evidence for some methods.
- Pre-emptive NSAIDs are not justified, while NMDA receptor antagonists represent a promising area for future research in pain management.
- Limited data exists regarding pre-emptive analgesia for chronic pain conditions like phantom limb pain.