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The classic definition of preemptive analgesia requires 2 groups of patients to receive identical treatment before or after incision or surgery. The only difference between the 2 groups is the timing of administration of the drug relative to incision. The constraint to include a postincision or postsurgical treatment group is methodologically appealing, because in the presence of a positive result, it provides a window of time within which the observed effect occurred, and thus points to possible mechanisms underlying the effect: the classic view assumes that the intraoperative nociceptive barrage contributes to a greater extent to postoperative pain than does the postoperative nociceptive barrage. However, this view is too restrictive and narrow, in part because we know that sensitization is induced by factors other than the peripheral nociceptive barrage associated with incision and subsequent noxious intraoperative events. A broader approach to the prevention of postoperative pain has evolved that aims to minimize the deleterious immediate and long-term effects of noxious perioperative afferent input. The focus of preventive analgesia is not on the relative timing of analgesic or anesthetic interventions, but on attenuating the impact of the peripheral nociceptive barrage associated with noxious preoperative, intraoperative, and/or postoperative stimuli. These stimuli induce peripheral and central sensitization, which increase postoperative pain intensity and analgesic requirements. Preventing sensitization will reduce pain and analgesic requirements. Preventive analgesia is demonstrated when postoperative pain and/or analgesic use are reduced beyond the duration of action of the target drug, which we have defined as 5.5 half-lives of the target drug. This requirement ensures that the observed effects are not direct analgesic effects. In this article, we briefly review the history of preemptive analgesia and relate it to the broader concept of preventive analgesia. We highlight clinical trial designs and examples from the literature that distinguish preventive analgesia from preemptive analgesia and conclude with suggestions for future research. 相似文献
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本文是一篇关于使用掺钕-钇、铝、石榴石激光(Neodymium-YAG Laser),治疗尿道狭窄的初步报告。介绍了一种以前未报道过的新技术,并分析了早期效果和并发症。其结果均用尿道造影和尿流计证实。作者相信,Nd:YAG激光是治疗尿道狭窄的一种安全而有效的方法。减少了治疗费用,并且病人在4~5天可恢复工作。 Nd:YAG激光是治疗各种泌尿科疾病的一种新器械。大多数采用该种激光作的研究一直是限于德国和日本。然而,目前美国对该种激光也很感兴趣。过去的报道集中在Nd:YAG激光治疗膀胱肿瘤和尖锐湿疣。曾采用激光治疗尿道狭窄,效果不确切。 相似文献
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