Pre-emptive analgesia

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Abstract
Pre-emptive analgesia, the concept of preventing pain after surgery by pretreatment, is well founded in basic neurophysiological animal research, and a few clinical studies seem to support this hypothesis. However, the mechanism behind this effect, that is, sensitization of central pain transmission neurons in the spinal cord dorsal horn, is activated by low-intensity C-fibre nociceptive input of short duration. Therefore, it cannot be possible to pre-empt all postoperative pain by treatment before surgery. Ongoing nociceptive impulse barrage of the spinal cord neurons from the surgical wound will continue long after the effect of any pretreatment has worn off. Pre-emptive analgesia will probably be effective and clinically meaningful only when started before surgery and continued for as long as nociceptors are stimulated in the postoperative wound area. Ongoing, prospective studies of the effect of perioperative pain management will, it is hoped, substantiate the presently meagre evidence that persistent postoperative neuropathic pain can be prevented by optimal perioperative pain management.

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