Preventive analgesia for postoperative pain control: a broader concept

Abstract

Nalini Vadivelu,1 Sukanya Mitra,2 Erika Schermer,3 Vijay Kodumudi,4 Alan David Kaye,5 Richard D Urman61Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India; 3Yale College, New Haven, 4School of Liberal Arts and Science, University of Connecticut, Storrs, CT, 5Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 6Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USAAbstract: Pain from surgical procedures occurs as a consequence of tissue trauma and may result in physical, cognitive, and emotional discomfort. Almost a century ago, researchers first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and long-term postoperative pain, now referred to as central sensitization. Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage. Pre-emptive analgesia is an important concept in understanding treatment strategies for postoperative analgesia. Pre-emptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively but not after surgical incision. Additional research in pre-emptive analgesia is warranted to better determine good outcome measurements and a better appreciation with regard to treatment optimization. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics.Keywords: preventive analgesia, central sensitization, chronic pain, pre-emptive analgesia, multimodal analgesia, acute pain