Pre‐emptive analgesia with local anaesthetic for herniorrhaphy

Abstract

SummaryThere is little evidence that local anaesthetics produce pre-emptive analgesia and one reason may be the short duration of action of the drugs studied. We examined the pre-emptive analgesic effect of a bupivacaine field block on postoperative pain in 40 patients following herniorrhaphy in a doubleblind, randomised trial. Patients received the block either after induction but before surgery, or after surgery but before the end of anaesthesia. There was no difference in pain scores or analgesic consumption up to 7 days after surgery between the two groups. We have demonstrated that bupivacaine does not appear to provide significant pre-emptive analgesia following a field block for herniorrhaphy. This study does not support the hypothesis that pre-emptive analgesia with local anaesthetic depends upon the duration of action of the drug.

Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain

“…Many recent clinical studies have failed to show any preemptive effect for many analgesic agents 3,5,7,8,12,19 . Methodological deficiencies may be the reason that has hindered the interpretation of these studies.…”

Atividade preemptiva da infiltração da incisão com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal

“…However, a metaanalysis has shown significant analgesic consumption decrease and longer time for rescue medication request, although not showing pain scores reduction with preemptive infiltration of local anesthetics as compared to postoperative infiltration 9 .…”

“…Some studies could not show beneficial effects with any preemptive drug, although others have shown preemptive effect only with non-steroid anti-inflammatory drugs (NSAIDS), local anesthetics and other drugs [2][3][4][5][6][7] . Local wound infiltration with local anesthetics has been recommended to decrease perioperative opioid consumption and postoperative pain, however there is a study which could not show differences in postoperative pain intensity with pre or postoperative infiltration with bupivacaína or lidocaine 2,8,9 . Decreased analgesic consumption and increased time for rescue drug request with bupivacaína infiltration before incision as compared to postoperative infiltration has been shown in meta-analysis, however there was no evidence of decreased postoperative pain intensity 10 .…”

“…Wound infiltration with local anesthetics has also been recommended to decrease perioperative opioid consumption 7 . In our study, pain intensity was evaluated by VAS, established method in the literature, since pain intensity described by patients has been referred as one of the most reliable measures to estimate analgesic treatment effectiveness 9 . Results obtained show that ropivacaine infiltration be- tion was made before incision.…”

Current status of pre-emptive analgesia

“…Of the seven negative pre-emptive studies, four [46,47,49,54] did not include an appropriate control group that would have allowed for the evaluation of preventive analgesic effects. In addition, the two negative pre-emptive studies that evaluated both preemptive and preventive effects [35,37] actually found a signi®cant reduction in cumulative analgesic intake between the preincisional and saline-treated control groups.…”