Pre-emptive analgesia and surgical pain

Abstract

Publisher Summary This chapter discusses the pre-emptive analgesia and surgical pain. The concept of pre-emptive analgesia purports that an analgesic intervention commenced before a nociceptive event will be more effective than the same analgesic intervention practised afterwards. Originally postulated on the basis of animal studies demonstrating central nervous system plasticity after nociception, this idea was introduced to clinical medicine with the hope of achieving substantial improvements in postoperative pain management. The presence of neuroplasticity is fundamental to the concept of pre-emptive analgesia. The neuroplasticity involves both inhibitory and excitatory components, whose net manifestation depends both on the time and place of measure. Preemptive analgesia with opioid agonists or N-methyl-D-aspartate (NMDA) receptor antagonists has a positive effect on both inhibitory and excitatory neuroplastic change after surgery. Evidence is further discussed that preoperative pain is also associated with altered central sensory processing and thus perhaps with increased vulnerability to further post-nociceptive neuroplastic change, particularly in the absence of analgesia during surgical nociception