| Abstract: | Preemptive analgesia is the idea that postoperative pain may be significantly attenuated using local anesthetics or opiates as a supplement to anesthesia, just prior to surgical incision. Basic research has shown that noxious inputs may trigger a state of spinal “central sensitization.” In this state innocuous stimuli are felt as painful. Central sensitization arises despite surgical anesthesia. Hence, by blocking the noxious inputs generated during surgery, central sensitization might be “preempted.” Clinical trials of this idea clearly have a favorable effect on postoperative pain. However, only a few studies have obtained evidence of preemption,ie, that it is essential to provide the analgesia immediately prior to surgery. Here we present the scientific rationale of preemptive analgesia, summarize the outcomes of clinical trials, and draw conclusions from the less-than-spectacular results obtained to date. |
