Affiliation
Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland.Issue Date
2012-02-03T15:11:04ZMeSH
Analgesics, Opioid/therapeutic use*Anesthesia, Conduction/trends
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Excitatory Amino Acid Antagonists/therapeutic use
Humans
Pain, Postoperative/*prevention & control
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Can J Anaesth. 2001 Dec;48(11):1091-101.Journal
Canadian journal of anaesthesia = Journal canadien d'anesthesieDOI
10.1007/BF03020375PubMed ID
11744585Abstract
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.Language
engISSN
0832-610X (Print)0832-610X (Linking)
ae974a485f413a2113503eed53cd6c53
10.1007/BF03020375
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