PREEMPTIVE ANALGESIA FOR POSTOPERATIVE PAIN CONTROL: IS IT POSSIBLE?

ALCIDES MOREIRA

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Introduction: Pain is inherent to human being, and its treatment is extremely important to prevent secondary complications, minimizing the morbidity of the surgical procedure. Several researchers in basic and clinical areas have struggled to find ways to minimize postoperative acute pain, reduce consumption of analgesics and reduce the risk of transition to chronic pain. Literature Review: The practice of treating pain only when it is already installed, have been replaced by preventive and preemptive approach. Preventive analgesia can be defined as an established analgesic regimen before the onset of the painful process. However, preemptive analgesia can be defined as a regimen established before the occurrence of noxious stimulus, in order to prevent peripheral and central sensitization, and subsequent amplification of pain. The preemptive analgesia concept was formulated initially in the early twentieth century, based on clinical observations, suggesting the use of regional anesthesia in addition to general anesthesia to prevent intraoperative nociception and pain caused by changes in the central nervous system. This idea was abandoned for a long time because the results obtained from animal researches did not exhibit the same satisfactory results when carried out in humans. In human research, when preventive and preemptive drugs were used in the same route of administration, randomly and double-blind, only with the administration of epidural analgesia, local anesthetic wound infiltration and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) appear to have a preemptive effect, whereas the use of systemic N-methyl-d-aspartic acid (NMDA) antagonists receptors and systemic opioids appears to offer no preemptive effect. Conclusions: The human subjectivity, methodological deficiencies and even the own individual variation of pain perception, are important factors that contribute to preemptive analgesia be a controversial theme.


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