Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000500011
Brazilian Journal of Anesthesiology
Review Article

Analgesia preemptiva

Preemptive analgesia

João Batista Santos Garcia; Adriana Machado Issy; Rioko Kimiko Sakata

Downloads: 7
Views: 1259

Resumo

JUSTIFICATIVA E OBJETIVOS: O controle da dor pós-operatória tem sido muito investigado nas últimas décadas, quando se verificou que a analgesia pós-operatória era inadequada. O termo "preemptiva" implica em uma forma de analgesia que, iniciada antes do estímulo doloroso ser gerado, previne ou diminui a dor subseqüente. Este estudo tem como objetivo uma atualização sobre analgesia preemptiva possibilitando novas alternativas para o tratamento da dor pós-operatória. CONTEÚDO: A analgesia preemptiva foi recomendada para prevenir a dor causada por mudanças no sistema nervoso central durante o ato operatório, devido à não supressão da condução do estímulo doloroso para o encéfalo. Vários estudos tanto laboratoriais como clínicos têm sido realizados com o intuito de demonstrar efeito preemptivo de métodos de analgesia, porém os resultados ainda são discutíveis e conflitantes. CONCLUSÕES: Apesar de existir algumas evidências clínicas do efeito da analgesia preemptiva, há necessidade de mais estudos para elucidar o real valor desse tipo de analgesia no controle da dor pós-operatória.

Palavras-chave

ANALGESIA, Preemptiva

Abstract

BACKGROUND AND OBJECTIVES: Postoperative pain control started to be more investigated in the last decade, when it has been observed that postoperative analgesia was inadequate. The word preemptive implies a type of analgesia which, induced before pain stimulation, prevents or minimizes subsequent pain. This study is an update on preemptive analgesia and provides new alternatives for postoperative pain relief. CONTENTS: Preemptive analgesia is recommended to prevent pain caused by central nervous system changes during surgery in consequence of the non-suppression of painful stimuli conduction to the brain. Many experimental studies in animals and humans have been performed to show a preemptive effect, but results are still unclear. CONCLUSIONS: Although some clinical evidences of the effects of preemptive analgesia, more studies are needed to determine the real value of this type of analgesia in controlling postoperative pain.

Keywords

ANALGESIA, Preemptive

References

Armitage EN. Postoperative pain-prevention or relief?. Br J Anaesth. 1989;63:136-138.

Mitchell RWD, Smith G. The control of acute postoperative pain.. Br J Anaesth. 1989;63:147-158.

Wildsmith FAW. Aspects of pain. Br J Anaesth. 1989;63:135.

Crile GW. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet. 1919;185:7-16.

Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983;306:686-688.

Wall PD. The prevention of postoperative pain. Pain. 1988;33:289-290.

McQuay HJ, Carrol D, Moore RA. Postoperative orthopedic pain - the effect of opiate premedication and local anaesthetic blocks.. Pain. 1988;33:291-295.

Bach S, Noreng MF, Tjéllden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade.. Pain. 1988;33:297-301.

Woolf CJ, Wall PD. Morphine sensitive and morphine insensitive actions of C-fibre input on the rat spinal cord.. Neurosci Lett. 1986;64:221-225.

McQuay HJ, DIckenson AH. Implications of nervous system plasticity for pain management.. Anaesthesia. 1990;45:101-102.

McQuay HJ. Preemptive analgesia. Br J Anaesth. 1992;69:1-3.

Kissin I. Preemptive analgesia - why its effect is not always obvious.. Anesthesiology. 1996;84:1015-1019.

Carr DB. Preemptive analgesia implies prevention.. Anesthesiology. 1996;85:1498.

Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth. 1989;63:139-146.

Woolf CJ, Chong MS. Preemptive analgesia - treating postoperative pain by preventing the establishment of central sensitization.. Anesth Analg. 1993;77:362-379.

Dray A. Inflammatory mediators of pain. Br J Anaesth. 1995;75:125-131.

Woolf CJ. Somatic pain - pathogenesis and prevention. Br J Anaesth. 1995;75:169-176.

Levine JD, Fields HL, Basbaum AI. Peptides and the primary afferent nociceptor. J Neurosci. 1993;13:2273-2286.

Stein C. Peripheral mechanisms of opioid analgesia.. Anesth Analg. 1993;76:182-191.

Coderre TJ, Katz J, Vaccarino AL. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52:259-285.

Katz J, Melzack R. Measurement of pain. Surg Clin N Am. 1999;79:231-252.

Vaccarino AL, Melzack R. Temporal process of formalin pain: differential role of the cingulum bundle, fornix pathway and medial bulboreticular formation.. Pain. 1992;44:257-271.

Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth. 1995;75:193-200.

Gozzani JL. Analgesia Pós-Operatória. Anestesiologia - Princípios e Técnicas. 1997:763-769.

Woolf CJ, Thompson SWN. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44:293-299.

Urban L, Thompson SWN, Dray A. Modulation of spinal excitability: co-operation between neurokinin and excitatory amino acid neurotransmitters. Trends Neurosci. 1994;17:432-438.

Schuman EM, Madison DV. -Nitric oxide and synaptic function. Annu. Rev Neurosci. 1994;17:153-183.

Dickenson AH, Sullivan AF. Evidence for a role of the NMDA receptor in the frequency dependent potentiation of deep rat dorsal horn nociceptive neurones following C fibre stimulation.. Neuropharmacology. 1987;26:1235-1238.

Gogas KR, Presley RW, Levine JD. The antinociceptive action of supraspinal opioids results from an increase in descending inhibitory control: correlation of nociceptive behavior and C-fos expression. Neurosci Lett. 1991;42:617-628.

Ren K. Wind-up and the NMDA receptor: from animal studies to humans. Pain. 1994;59:157-158.

Yashpal K, Mason P, Mckenna JE. Comparison of the effects of treatment with intrathecal lidocaine given before and after formalin on both nociception and Fos expression in the spinal cord dorsal horn.. Anesthesiology. 1998;88:157-164.

Li J, Simone DA, Larson AA. Wind-up leads to characteristics of central sensitization. Pain. 1999;79:75-82.

Woolf CJ. Wind-up and central sensitization are not equivalent.. Pain. 1996;66:105-108.

Dickenson AH, Sullivan AF. Peripheral origins and central modulation of subcutaneous formalin-induced activity of rats dorsal horn neurones.. Neurosci Lett. 1987;83:207-211.

Tjolsen A, Berge O, Hunskaar S. The formalin test: an evaluation of the method. Pain. 1992;51:5-8.

Dickenson AH, Sullivan AF. Subcutaneous formalin-induced activity of dorsal horn neurones in the rat: differential response to an intrathecal opiate administered pre or post formalin. Pain. 1987;30:349-353.

Yamamoto T, Yaksh TL. Comparison of the antinociceptive effects of pre- and post-treatment with intrathecal morphine and mk801, an NMDA antagonist, on the formalin test in the rat.. Anesthesiology. 1992;77:757-761.

Chapman V, Haley JE, Dickenson AH. Electrophysiologic analysis of preemptive effects of spinal opioids on N-methyl D-aspartate receptor-mediated events.. Anesthesiology. 1994;81:1429-1435.

Abram SE, Yaksh TL. Morphine, but not inhalation anesthesia, blocks pos-injury facilitation.. Anesthesiology. 1993;78:713-721.

Goto T, Marota JJA, Crosby G. Nitrous oxide induces preemptive analgesia in the rat that is antagonized by halothane.. Anesthesiology. 1994;80:409-416.

O'Connor TC, Abram SE. Inhibition of nociception-induced spinal sensitization by anesthetic agents.. Anesthesiology. 1995;82:259-266.

Goto T, Marota JJA, Crosby G. Pentobarbitone, but not propofol, produces preemptive analgesia in the rat formalin model.. Br J Anaesth. 1994;72:662-667.

Gilron I, Coderre TJ. Preemptive analgesic effects of steroid anesthesia with alphaxalone in the rat formalin test: evidence for differential GABA A receptor modulation in persistent nociception.. Anesthesiology. 1996;84:572-579.

Yashpal K, Katz J, Coderre TJ. Effects of preemptive or postinjury intrathecal local anesthesia on persistent nociceptive responses in rats. Anesthesiology. 1996;84:1119-1128.

Brennan TJ, Umali EF, Zahn PK. Comparison of pre- versus post-incision administration of intrathecal bupivacaine and intrathecal morphine in a rat model of postoperative pain.. Anesthesiology. 1997;87:1517-1528.

Hartrick CT, Wise JJ, Patterson JS. Preemptive intrathecal ketamine delays mechanical hyperalgesia in the neurophatic rat. Anesth Analg. 1998;86:557-560.

Gilron I, Quirion R, Coderre TJ. Pre-versus postformalin effects of ketamin or large-dose alfentanil in the rat: discordance between pain behavior and spinal Fos-like immunoreactivity.. Anesth Analg. 1999;89:128-135.

Rice LJ, Pudimat MA, Hannallah RS. Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients.. Can J Anaesth. 1990;37:429-433.

Gunter JB, Forestner JE, Manley CB. Caudal epidural anesthesia reduces blood loss during hypospadias repair. J Urol. 1990;144:517-519.

Ho JSW, Khambatta HJ, Pang LM. Preemptive analgesia in children. Does it exist?. Reg Anesth. 1997;22:125-130.

Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children.. Anesth Analg. 1998;87:52-56.

Pryle BJ, Vanner RG, Enriquez N. Can pre-emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?. Anesthesia. 1993;48:120-123.

Dakin MJ, Osinubi OYO, Carli F. Preoperative spinal anesthesia does not reduce postoperative morphine requirements in women undergoing total abdominal hysterectomy.. Reg Anesth. 1996;21:99-102.

Katz J, Clairoux M, Kavanagh BP. Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery. Pain. 1994;59:395-403.

Aguilar JL, Rincón R, Domingo V. Absence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery. Br J Anaesth. 1996;76:72-76.

Dierking GW, Dahl JB, Kanstrup J. Effect of pre vs postoperative inguinal field block on postoperative pain after herniorraphy. Br J Anaesth. 1992;68:344-348.

Campbell WI, Kendrick RW. Pre-emptive analgesia using local anaesthesia: a study in bilaterally symetrical surgery.. Br J Anaesth. 1997;79:657-659.

Turner GA, Chalkiadis G. Comparison of preoperative with postoperative lignocaine infiltration on postoperative analgesic requirements.. Br J Anaesth. 1994;72:541-543.

Dahl V, Raeder JC, Erno PE. Pre-emptive effect of pre-incisional versus post-incisional infiltration of local anaesthesia on children undergoing hernioplasty. Acta Anaesthesiol Scand. 1996;40:847-851.

Ejlersen E, Andersen HB, Eliasen K. A comparison between preincisional and postincisional lidocaine infiltration and postoperative pain. Anesth Analg. 1992;74:495-498.

Ke RW, Portera SG, Bagous W. A randomized, double-blind trial of preemptive analgesia in laparoscopy. Obstet Ginecol. 1998;92:972-975.

Pasqualucci A, De Angelis V, Contardo R. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. Anesthesiology. 1996;85:11-20.

Bourget JL, Clark J, Joy N. Comparing preincisional with postincisional bupivacaine infiltration in the management of postoperative pain.. Arch Surg. 1997;132:766-769.

Dahl JB, Hansen BL, Hjortso NC. Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery.. Br J Anaesth. 1992;69:4-8.

Dahl JB, Daugaard JJ, RasmusseN B. Immediate and prolonged effects of pre versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty. Acta Anaesthesiol Scand. 1994;38:557-561.

Katz J, Kavanagh BP, Sandler AN. Preemptive analgesia - clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology. 1992;77:439-446.

Gill MG, Aguado RG, Rosso MT. Estudio comparativo entre morfina epidural lumbar preventiva o postincisional en cirurgía resectiva pulmonar. Informe preliminar.. Rev Esp Anestesiol Reanim.. 1998;45:384-388.

Kundra P, Gurnani A, Bhattacharya A. Preemptive epidural morphine for postoperative pain relief after lumbar laminectomy. Anesth Analg. 1997;85:135-138.

Richmond CE, Bromley LM, Woolf CJ. Preoperative morphine pre-empts postoperative pain.. Lancet. 1993;342:73-75.

Kiliçkan L, Toker K. The effects of pre-emptive intravenous (IV) morphine on postoperative analgesia and surgical stress response. IMRA. 1998;10:18.

Mansfield M, Meikle R, Miller C. A trial of pre-emptive analgesia - influence of timing of preoperative alfentanil on postoperative pain and analgesic requirements.. Anaesthesia. 1994;49:1091-1093.

Wilson RJT, Leith S, Jackson IJB. Pre-emptive analgesia from intravenous administration of opioids. No effect with alfentanil. Anaesthesia. 1994;49:591-593.

Griffin MJ, Hughes D, Knaggs A. Late-onset preemptive analgesia associated with preincisional large-dose alfentanil. Anesth Analg. 1997;85:1317-1321.

Fassoulaki A, Sarantopoulos C, Zotou M. Preemptive opioid analgesia does not influence pain after hysterectomy.. Can J Anaesth. 1995;42:109-113.

Sarantopoulos C, Fassoulaki A. Sufentanil does not preempt pain after abdominal hysterectomy. Pain. 1996;65:273-276.

Choe H, Choi Y, Kim Y. Epidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration. Anesth Analg. 1997;84:560-563.

Wong C, Lu C, ChernG C. Pre-emptive analgesia with ketamine, morphine and epidural lidocaine prior to total knee replacement.. Can J Anaesth. 1997;44:31-37.

Kucuk N, Kizilkaya M, Tokdemir M. Preoperative epidural ketamine does not have a postoperative opioid sparing effect.. Anesth Analg. 1998;87:103-106.

Adam F, Libier M, Oszustowicz T. Preoperative small - dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy. Anesth Analg. 1999;89:444-447.

Wu C, Yu J, Yeh C. Preincisional dextromethorphan teatment decreases postoperative pain and opioid requirement after laparoscopic cholecystectomy. Anesth Analg. 1999;88:1331-1334.

Rockemann MG, Seeling W, Bischof C. Prophylatic use of epidural mepivacaine/morphine, systemic diclofenac, and metamizole reduces postoperative morphine consumption after major abdominal surgery.. Anesthesiology. 1996;84:1027-1034.

Espinet A, Henderson DJ, Faccenda KA. Does preincisional thoracic extradural block combined with diclofenac reduce postoperative pain after abdominal hysterectomy?. Br J Anaesth. 1996;76:209-213.

Flath RK, Hicks ML, Dionne RA. Pain supression after pulpectomy with preoperative flurbiprofen.. J Endod. 1987;13:339-347.

Sisk AL, Mosley RO, Martin RP. Comparison of preoperative and postoperative diflunisal for supression of postoperative pain.. J. Oral Maxillofac Surg. 1989;47:464-468.

Sisk AL, Grover BJ. A comparison of preoperative and postoperative naproxen sodium for supression of postoperative pain.. J Oral Maxillofac Surg. 1990;48:674-678.

Coli A, Lari S, Viganò E. Valutazione dell'efficacia dei FANS nella prevenzione del dolore postoperatorio. Confronto tra somministrazione pre e postoperatoria di naprossene sodico in chirurgia ortopedica.. Minerva Anestesiol. 1993;59:531-535.

Sandin R, Sternlo J, Stam H. Diclofenac for pain relief after arthroscopy: a comparison of early and delayed treatment. Acta Anaesthesiol Scand. 1993;37:747-750.

Bünemann L, Thorshauge H, Herlevsen P. Analgesia for outpatient surgery: placebo versus naproxen sodium (a non-steriodal anti-inflammatory drug) given before or after surgery. Eur J Anaesth. 1994;11:461-464.

Rogers JEG, Fleming BG, Macintosh KC. Effect of timing of ketorolac administration on patient-controlled opioid use.. Br J Anaesth. 1995;75:15-18.

Fletcher D, Zetlaoui P, Monin S. Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery. Pain. 1995;61:291-297.

Bridgman JB, Gillgrass TG, Zacharias M. The absence of any pre-emptive analgesic effect for non-steroidal anti-inflammatory drugs. Br J Oral Maxillofac Surg. 1996;34:428-431.

O'Hanlon JJ, Muldoon T, Lowry D. Improved postoperative analgesia with preoperative piroxican.. Can J Anaesth. 1996;43:102-105.

Vanlersberghe C, Lauwers MH, Camu F. Preoperative ketorolac administration has no preemptive analgesic effect for minor orthopaedic surgery. Acta Anaesthesiol Scand. 1996;40:948-952.

Módolo NSP, Gurgel S, Neves LB. Avaliação da analgesia com tenoxicam na sala de recuperação pós-anestésica. Rev Bras Anestesiol. 1998;48(^s23):S37.

Aida S, Baba H, Yamakura T. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999;89:711-718.

Niv D, Lang E, Devor M. The effect of preemptive analgesia on subacute postoperative pain. Minerva Anestesiol. 1999;65:127-141.

5dd7f35c0e8825480d13f286 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections