Pre Emptive Analgesia: A New Dimension in Pain Management

Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage, leading to an intensification of acute pain and even long-term postoperative pain, referred to as central sensitization. Chronic postsurgical pain (CPSP) seen in 10 to 50 % of post surgical patients persists for 36 months after surgery and disrupts their quality of life. Pre-emptive analgesia (PEA) involves the introduction of an analgesic regimen before the onset of noxious stimuli, (not after surgical incision). This prevents this central sensitization and chronic neuropathic syndromes. Treatment strategies involve short and long term techniques started preoperatively and given for an increased duration in the postoperative period to decrease postoperative pain and reducing analgesic consumption in the postoperative period. Preemptive analgesia involves delivery of analgesic therapy that precedes, adequately blocks, and out-lasts the nociceptive stimuli that accompany tissue injury in order to prevent the peripheral and central sensitization that occurs in response to painful stimuli, while leaving physiological pain responses intact. This allows for a more rapid recovery and earlier discharge from hospital.