This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kelly, D. J. Articles by Brull, S. J. Search for Related Content PubMed PubMed Citation Articles by Kelly, D. J. Articles by Brull, S. J.

Preemptive analgesia II: recent advances and current trends

[L’analgésie préventive II : progrès récents et nouvelle orientation]

Dermot J. Kelly, MRCPI FFARCSI^*, Mahmood Ahmad, MD and Sorin J. Brull, MD

^* From the Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland and
the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.

Dr. Sorin J. Brull, Professor and Chairman, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot 515, Little Rock, AR 72205-7199, U.S.A. Phone: 501-686-6119; Fax: 501-603-1421; Sorin.Brull{at}uams.edu

Purpose: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia.

Source: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents.

Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy.

Conclusion: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

This article has been cited by other articles:

				A. Gottschalk, M. Freitag, E. Steinacker, S. Kreissl, C. Rempf, H.-J. Staude, T. Strate, and T. Standl Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery Br. J. Anaesth., January 1, 2008; 100(1): 36 - 41. [Abstract] [Full Text] [PDF]

				Y. U. Adachi, H. Sano, M. Doi, and S. Sato Preemptive Analgesia by Nonsteroidal Antiinflammatory Drugs Anesth. Analg., November 1, 2006; 103(5): 1331 - 1332. [Full Text] [PDF]

				C. K.-S. Ong, P. Lirk, R. A. Seymour, and B. J. Jenkins The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A Meta-Analysis Anesth. Analg., March 1, 2005; 100(3): 757 - 773. [Abstract] [Full Text] [PDF]

				D. G. Ririe, D. Barclay, H. Prout, C. Tong, J. R. Tobin, and J. C. Eisenach Preoperative Sciatic Nerve Block Decreases Mechanical Allodynia More in Young Rats: Is Preemptive Analgesia Developmentally Modulated? Anesth. Analg., July 1, 2004; 99(1): 140 - 145. [Abstract] [Full Text] [PDF]

				W. H. Wurm, M. Concepcion, A. Sternlicht, J. M. Carabuena, G. Robelen, L. C. Goudas, S. A. Strassels, and D. B. Carr Preoperative Interscalene Block for Elective Shoulder Surgery: Loss of Benefit over Early Postoperative Block After Patient Discharge to Home Anesth. Analg., December 1, 2003; 97(6): 1620 - 1626. [Abstract] [Full Text] [PDF]

				D. Karovic, S. Blumenthal, A. Schneeberger, A. Borgeat, J. M. Neal, S. B. McDonald, and K. L. Larkin Suprascapular Nerve Block Prolongs Analgesia After Nonarthroscopic Shoulder Surgery but Does Not Improve Outcome: Suprascapular Nerve Blocked One, Two...or More Times? * Response Anesth. Analg., October 1, 2003; 97(4): 1195 - 1196. [Full Text] [PDF]