Preemptive analgesia: Moving beyond conventional strategies and confusing terminology

Trials of preemptive analgesia compare the effect of drugs administered before injury with the same treatment administered after injury, whereas studies of perioperative analgesia include comparisons of preinjury administration with no particular analgesic treatment at all. In contrast to earlier reports, recent animal behavioral studies of persistent nociception and clinical trials of preemptive analgesia using randomized, controlled protocols strongly indicate that conventional treatments such as local anesthetics and opioids do not exhibit significant preemptive analgesic effects for postoperative pain. The direction of perioperative medicine must be shifted away from conventional preemptive analgesia studies, and towards (1) preemptive analgesia studies using novel treatment strategies; (2) perioperative analgesic strategies involving continuous administration of analgesics and anesthetics; and (3) a focus on clinical outcomes involving hospital stay, cost, and patient satisfaction.