Pre-emptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children

Abstract

We have compared in 25 children the effect of preoperative with postoperative caudal block on pain after circumcision in a double-blind, randomized study. After induction of anaesthesia, patients were allocated randomly to receive a caudal block either before (n = 14) or immediately after (n = 11) surgery. Postoperative pain was rated on a paediatric pain scale. If pain occurred, children received paracetamol in a dose related to body weight. Using the Mann-Whitney U test (significance < or = 0.05) there was no significant difference in cumulative postoperative analgesic requirements within the first 48 h and in times to first analgesic administration between the groups. Cumulative pain score, assessed every 30 min for the first 8 h after operation, was significantly lower for those patients who received caudal anaesthesia after operation. Thus we could not demonstrate any advantage in performing caudal block before compared with after surgery.

Pre-Emptive Analgesia: How Important Is It in Clinical Reality?

“…The authors stress, however, that the intensity ranges and duration of pain provoked by this type of surgery may not be quantitatively sufficient to demonstrate significant differences between pre-emptive treated and combined pre-and postsurgerytreated patients [23]. (table 2): Three studies, two paediatric [24,25] and one adult study [26] using epidural local anaesthetics, failed to show any advantage between the pretreated versus the postincisional groups. Only one adult study [27] showed that the use of a single dose lumbar epidural bupivacaine before lower abdominal surgery significantly reduced postoperative PCA morphine consumption up to 48 h postoperation.…”

Preemptive analgesia: No relevant advantage of preoperative compared with postoperative intravenous administration of morphine, ketamine, and clonidine in patients undergoing transperitoneal tumor nephrectomy☆

“…6,7 Clinical studies, however, delivered contradictory, often negative results, 1,8-10 even with designs close to experimental studies. 11 In those cases, in which preemptive analgesia was observed, the effects were of relatively small magnitude. 12 Reasons promulgated for the disappointing observations are an insufficient attenuation of the nociceptive input or its processing, respectively.…”

Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair

“…Nevertheless, several investigations comparing pre-versus postoperative infiltration or nerve block with local anesthetics in other types of surgery have failed to show that preemptive administration reduces postoperative pain or supplementary analgesic requirements. [38][39][40][41][42][43] Ejlersen et al 44 found that the requirements for supplemental postoperative analgesics were lower in the preoperative infiltration group compared to patients who received infiltration with lidocaine after inguinal hernia repair. However, they did not record pain scores or analgesic consumption beyond 6 hours after surgery.…”