Involvement of presurgical pain in preemptive analgesia for orthopedic surgery: a randomized double blind study

Abstract

Preemptive analgesia (PA) is effective in animal models but its clinical effectiveness remains controversial. We examined the effect of preexisting pain on PA. Subjects were recruited from patients needing orthopedic surgery. Some had presurgical pain (fracture surgery and arthritic surgery), while others had no presurgical pain (removal surgery for a tumor, nail or plate). Epidural morphine or a saline control was given preemptively before surgery and maintained until skin closure. Following skin closure, naloxone or placebo was injected intravenously to erase the aftereffects of the morphine. After total recovery, the PCA pump was set to inject epidural morphine. Pain intensity after surgery was measured by a visual analogue scale (VAS), and the amount of morphine used within 48h after surgery. PA was significantly effective for removal surgery, but ineffective for fracture or arthritic surgery. For the fracture and arthritic surgery PA treatment groups, there was a significant correlation between pre- and postsurgical (6h) spontaneous pain, while the corresponding control groups showed no significant correlation. Postsurgical VAS values in the fracture and arthritic surgery control groups increased significantly compared with presurgical VAS values. PA was effective when presurgical pain was absent, but ineffective when presurgical pain was present. We propose that central sensitization is already established by presurgical pain, and preserved until the termination of surgery. The ineffectiveness of PA did not depend on whether the pain was acute (fracture surgery) or chronic (arthritic surgery).

Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery

“…[5][6][7][8][9][10] This can be explained in part by the variety of types and sites of surgery, 11 or by the presence or absence of pain before surgery. 12 In a recently published review Moiniche et al pointed out that preemptive continuous epidural treatment extending into the postoperative period might have an improved capacity to reduce nociceptive input and thereby central neuroplasticity caused not only by incision and ongoing surgery but also by postsurgical inflammation. 13 For this reason standardized studies are necessary for different types of surgery, patients and treatment.…”

“…As described by Aida et al central sensitization seems to be already established by pre-surgical acute or chronic pain and preserved until the termination of surgery. 12 Therefore we included only patients with a preoperative VAS score for pain at rest of 10 mm or less.…”

Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

“…10,11,29,69,70,72 Because there are inadequate data for pain assessment in orthopedic surgeries, more data must be collected to better predict postoperative pain in order to improve pain management. 2,13,14,46,56,57 …”

Lornoxicam bei gynäkologischen Eingriffen

“…In den letzten Jahren wurde dieser theoretische Ansatzpunkt in zahlreichen Studien untersucht [5,15,20]. Die Arbei-ten wurden mit unterschiedlichen Medikamenten und verschiedenen Applikationsarten (spinal, epidural, systemisch) [2,14,19,25,34,35,36] durchgeführt. Der zentrale Sensibilisierungsprozess wird durch schmerzhafte Stimuli bei Operationsbeginn, während der Operation, und bis zum Ende der Wundheilung unterhalten.…”