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dc.contributor.authorKelly, D J
dc.contributor.authorAhmad, M
dc.contributor.authorBrull, S J
dc.date.accessioned2012-02-03T15:11:10Z
dc.date.available2012-02-03T15:11:10Z
dc.date.issued2012-02-03T15:11:10Z
dc.identifier.citationCan J Anaesth. 2001 Nov;48(10):1000-10.en_GB
dc.identifier.issn0832-610X (Print)en_GB
dc.identifier.issn0832-610X (Linking)en_GB
dc.identifier.pmid11698320en_GB
dc.identifier.doi10.1007/BF03016591en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209059
dc.description.abstractPURPOSE: 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.
dc.language.isoengen_GB
dc.subject.meshAdrenergic alpha-Antagonists/therapeutic useen_GB
dc.subject.meshAnalgesia/*methodsen_GB
dc.subject.meshAnalgesics, Opioid/therapeutic useen_GB
dc.subject.meshAnesthesia, Conductionen_GB
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal/therapeutic useen_GB
dc.subject.meshEfferent Pathways/physiologyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshPain/physiopathologyen_GB
dc.subject.meshPain, Postoperative/*prevention & controlen_GB
dc.subject.meshPerceptionen_GB
dc.subject.meshPremedicationen_GB
dc.subject.meshReceptors, N-Methyl-D-Aspartate/antagonists & inhibitorsen_GB
dc.titlePreemptive analgesia I: physiological pathways and pharmacological modalities.en_GB
dc.contributor.departmentDepartment of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland.en_GB
dc.identifier.journalCanadian journal of anaesthesia = Journal canadien d'anesthesieen_GB
dc.description.provinceMunster
html.description.abstractPURPOSE: 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.


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