Preoperative morphine pre-empts postoperative pain

Richmond, Catherine; Bromley, Lesley; Woolf, Clifford J.

doi:10.1016/0140-6736(93)91284-s

Cited by 249 publications

(71 citation statements)

References 13 publications

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“…Only few studies have examined the effect of pre-emptive analgesia on spinal sensitization; we have found none for SIA or DNIC. Richmond, Bromley and Woolf [9] and Collis and colleagues [10] found that mechanical secondary hyperalgesia was suppressed by preemptive morphine, but they did not give absolute thresholds. On a single occasion after operation, Lund, Hansen and Kehlet found an increased electric sensation threshold [11], while electric pain thresholds were decreased (and the nociceptive withdrawal reflex increased) in another study [12].…”

Section: Discussionmentioning

confidence: 99%

“…Richmond, Bromley and Woolf [9] and Collis and colleagues [10], studying pre-emptive morphine for hysterectomy, found postoperative differential (i.e. forearm-abdomen) pain detection thresholds to mechanical stimulation to be smaller in the pre-emptive group, suggesting less spinal sensitization.…”

Section: Discussionmentioning

confidence: 99%

“…Possible sensitization by threshold measurements was minimized by spacing the measures, doing only three runs and stopping on just reaching the pain tolerance threshold. In common with other groups [9,10] we normalized thresholds relative to the arm. Because the arm was far away from the surgical site, it was unlikely to be affected by segmental or spinal sensory changes after operation, while still being subject to any generalized or supraspinal changes, making possible separation of the two types of altered sensory processing.…”

Section: Discussionmentioning

confidence: 99%

“…To separate generalized from segmental (spinal) effects on thresholds, normalized (or relative) and raw thresholds were analysed. Thresholds were normalized relative to the arm [9,10] …”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Surgical pain is followed not only by spinal sensitization but also by supraspinal antinociception

Wilder‐Smith¹,

Tassonyi²,

Senly³

et al. 1996

British Journal of Anaesthesia

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SummaryNociception can produce segmental spinal sensitization or descending supraspinal antinociception. We assessed both types of sensory change after surgery during isoflurane-nitrous oxide anaesthesia with or without fentanyl before nociception. Patients undergoing back surgery received fentanyl 3 g kg 91 (n : 15) or placebo (n : 15) before anaesthesia in a prospective, randomized, blinded study. Sensation, pain detection and tolerance thresholds to electrical stimulation were measured before operation at the arm, incision and herniated disc dermatomes (HDD) and 1, 2, 4, 6, 24 h and 5 days after operation, together with pain scores and patient-controlled morphine consumption (duration 24 h). For segmental effects, thresholds were normalized to the thresholds at a distant dermatome (arm). Raw pain thresholds were increased after operation (fentanyl 9 placebo) and were maximal at 4 h (pain tolerance in HDD: fentanyl ;5.2 mA (;62.7 %), placebo, ;3.8 mA (;44.2 %); P : 0.05 vs baseline for both).Normalized sensation thresholds decreased for placebo only (HDD/4 h : placebo, 91.8 (944.8 %), P : 0.05; fentanyl, ;0.1 (;5.5 %) ns). All changes returned to baseline by 24 h except for the placebo group normalized HDD sensation (d5: placebo, 92.4 (959.7) %, P : 0.05; fentanyl 90.1 (95.5 %) ns). Pain scores and morphine consumption were similar. The study demonstrated both supraspinal analgesia and spinal sensitization after surgery. Fentanyl administration before operation augmented the former while decreasing the latter, and hence sensitization, especially if neuropathic, may particularly benefit from pre-emptive analgesia. (Br.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…To separate generalized from segmental (spinal) effects on thresholds, normalized (or relative) and raw thresholds were analysed. Thresholds were normalized relative to the arm [9,10] …”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Surgical pain is followed not only by spinal sensitization but also by supraspinal antinociception

Wilder‐Smith¹,

Tassonyi²,

Senly³

et al. 1996

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Richmond et al 69 observed that the administration of 10 mg intravenous morphine before hysterectomy reduces opioid consumption during the first 24 postoperative hours, as well as painful sensitivity around the surgical incision as compared to the same dose administered at the end of the surgery. Kiliçkan et al 70 , also in patients submitted to hysterectomy, obtained total morphine consumption reduction with 0.15 mg.kg -1 intravenous morphine before surgical incision.…”

Section: Systemicmentioning

confidence: 99%

Analgesia preemptiva

Garcia¹,

Issy²,

Sakata³

2001

Rev. Bras. Anestesiol.

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A Rat Model of Postoperative Pain

Brennan

2004

CP Pharmacology

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Research on pain resulting from an incision is crucial for developing therapies for postoperative pain, a condition for which effective and inexpensive treatments are not yet available. Because of the gap between preclinical models of persistent pain (e.g., inflammatory, neuropathic) and acute postsurgical pain, efforts have been undertaken to develop methods for studying pain caused by incisions. To this end, a rat model for postoperative pain has been developed. The model uses a plantar incision in the hindpaw and is characterized by persistent, reduced withdrawal thresholds to mechanical stimuli, as is the case in patients after surgery. The pain behaviors are greatest immediately after recovery from anesthesia. The enhanced responsiveness remains remarkable for several days and then gradually decreases. The model is useful for screening test compounds that may be effective in reducing postoperative pain and for understanding pain mechanisms associated with incisions.

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Preoperative morphine pre-empts postoperative pain

Cited by 249 publications

References 13 publications

Surgical pain is followed not only by spinal sensitization but also by supraspinal antinociception

Surgical pain is followed not only by spinal sensitization but also by supraspinal antinociception

Analgesia preemptiva

A Rat Model of Postoperative Pain

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