Preemptive analgesia in foot and ankle surgery
- PMID: 12776979
- DOI: 10.1016/S0891-8422(03)00005-3
Preemptive analgesia in foot and ankle surgery
Abstract
Central neuroplasticity, or changes in CNS processing due to surgical nociception. can amplify postoperative pain. As a result, a hyperalgesic state called wind-up can occur, having debilitating effects on postoperative patients. Preemptive analgesia works to prevent this process and results in a more positive surgical experience. Inhibition of afferent pain pathways by use of local anesthetic blocks, altered perception of pain with opioid use, and inhibition of pain pathways by NMDA receptor antagonists are examples of preemptive analgesia. Using a combination of preemptive modalities and addressing patients' perceptions can aid in interrupting pathologic pain cycles. Positive and modest results have been obtained from animal and human preemptive trials, yet basic pathophysiology demonstrates the validity and importance of preemptive analgesia. Future studies are needed to test effective blockade of afferent input while controlling perception, hyperalgesia, and NMDA receptor activity. The Agency for Health Care Policy and Research now recommends a multifaceted approach to postoperative pain. The goal in pain management is to inhibit destructive pain pathways, maintain intraoperative analgesia, and prevent central sensitization. Preliminary results of multimodal preemptive analgesia trials continue to be promising.
Similar articles
-
From preemptive to preventive analgesia.Curr Opin Anaesthesiol. 2006 Oct;19(5):551-5. doi: 10.1097/01.aco.0000245283.45529.f9. Curr Opin Anaesthesiol. 2006. PMID: 16960490 Review.
-
Perioperative pain control.Clin Podiatr Med Surg. 2003 Apr;20(2):257-67. doi: 10.1016/S0891-8422(03)00006-5. Clin Podiatr Med Surg. 2003. PMID: 12776980 Review.
-
New concepts in acute pain therapy: preemptive analgesia.Am Fam Physician. 2001 May 15;63(10):1979-84. Am Fam Physician. 2001. PMID: 11388713 Review.
-
Preemptive analgesia for postoperative pain relief in lumbosacral spine surgeries: a randomized controlled trial.Spine J. 2004 May-Jun;4(3):261-4. doi: 10.1016/j.spinee.2003.11.009. Spine J. 2004. PMID: 15125846 Clinical Trial.
-
Preemptive analgesia I: physiological pathways and pharmacological modalities.Can J Anaesth. 2001 Nov;48(10):1000-10. doi: 10.1007/BF03016591. Can J Anaesth. 2001. PMID: 11698320 Review.
Cited by
-
Analgesic efficacy of local versus proximal nerve blocks after hallux valgus surgery: a systematic review.J Foot Ankle Res. 2022 Oct 22;15(1):78. doi: 10.1186/s13047-022-00581-0. J Foot Ankle Res. 2022. PMID: 36273159 Free PMC article.
-
Comparison of the effects of parecoxib and diclofenac in preemptive analgesia: A prospective, randomized, assessor-blind, single-dose, parallel-group study in patients undergoing elective general surgery.Curr Ther Res Clin Exp. 2004 Sep;65(5):383-97. doi: 10.1016/j.curtheres.2004.10.004. Curr Ther Res Clin Exp. 2004. PMID: 24672093 Free PMC article.
-
Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study.J Pain Res. 2018 Apr 26;11:867-873. doi: 10.2147/JPR.S153456. eCollection 2018. J Pain Res. 2018. PMID: 29731664 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials