Preemptive analgesia I: physiological pathways and pharmacological modalities.
Affiliation
Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland.Issue Date
2012-02-03T15:11:10ZMeSH
Adrenergic alpha-Antagonists/therapeutic useAnalgesia/*methods
Analgesics, Opioid/therapeutic use
Anesthesia, Conduction
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Efferent Pathways/physiology
Humans
Pain/physiopathology
Pain, Postoperative/*prevention & control
Perception
Premedication
Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors
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Can J Anaesth. 2001 Nov;48(10):1000-10.Journal
Canadian journal of anaesthesia = Journal canadien d'anesthesieDOI
10.1007/BF03016591PubMed ID
11698320Abstract
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: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.Language
engISSN
0832-610X (Print)0832-610X (Linking)
ae974a485f413a2113503eed53cd6c53
10.1007/BF03016591
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