The effect of pre-emptive analgesia on the level of postoperative pain in women undergoing surgery for breast neoplasm

Abstract

Aim of the studyDynamic development of research on pain has resulted in the formulation of the concept of pre-emptive analgesia, which involves administration of analgesics before the first pain-producing stimulus appears. It is meant to prevent increased sensitivity to pain in the postoperative period. The aim of this study was to assess the possibilities of modifying the intensity of postoperative pain evaluated with the visual analogue scale (VAS) in patients after surgical treatment for breast neoplasm offered by pre-emptive analgesia.Material and methodsThe intensity of postoperative pain was measured immediately after the surgery as well as 6, 12, 18, and 24 hours later in 100 women who had undergone surgery for breast tumour. The correlation between experienced pain and the type of analgesic administered pre-emptively, including metamizole, tramadol, ketoprofen, and placebo was examined. The effect of other correlates such as the extensiveness of surgery, systolic and diastolic blood pressure, and heart rate on the level of experienced pain as well as the usefulness of physiological parameters for its assessment were also analysed.ResultsThe conducted study demonstrated the effectiveness of tramadol (p = 0.004) and ketoprofen (p = 0.039) administered half an hour before the beginning of surgery, but there was no similar effect in the case of metamizole (p = 1.0). A positive correlation was observed between the level of experienced pain and blood pressure values (p < 0.001). Heart rate does not seem to be significantly linked with the intensity of experienced pain (p = 0.157).

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

“…T he idea of preemptive analgesia was first proposed by Woolf in Harvard Medical School 8 , with the purpose to block the pain sensation center before harmful stimulation occurs, to inhibit the center sensitization and to raise the threshold of pain sensation. Recently, there have been many studies published on the preoperative use of local anesthesia agents, including opiates and NSAIDS [9][10][11][12] , but the value of preemptive analgesia is still controversial [13][14][15] . It has been proved that synthesis of COX-2 increases after inflammatory stimulation, and increases the production of prostaglandins, which induces inflammatory pain.…”

The Use of Preemptive Ketamine for the Prevention of Postoperative Pain in Surgical Patients

“…Data was collected at 6, 12, 18, and 24 hours post-operatively. The authors found that patients had significantly less pain post-operatively when they received preemptive pain medication (in this case, tramadol or ketoprofen) than those patients who did not receive any medication, thus highlighting the effectiveness of preemptive pain medication on post-operative pain control (Wegorowski et al, 2016).…”

“…When pain is left untreated, hyperalgesia, alterations in pain processing and chronic pain may ultimately develop (Kelly, et al, 2001). Chronic pain may develop from acute post-operative pain in up to 50% of patients after surgeries such as amputations, breast surgery, or inguinal hernioplasty (Wegorowski, et al, 2016).…”

“…Preventing sensitization is the basis for preemptive analgesia. It has also been well documented that preemptive use of pain medication prior to the application of noxious stimuli results in better-controlled pain versus waiting to treat pain until the noxious stimuli has already occurred (Wegorowski et al, 2016). For example, prostaglandins and leukotrienes, when released from damaged tissue increase the transduction of painful stimuli by reducing the pain threshold of peripheral pain receptors and increasing their responsiveness (Kelly, et al, 2001).…”

“…A double-blind study performed by Wegorowski et al (2016) aimed to evaluate the effects of analgesics used pre-emptively on the level of post-operative pain intensity felt by female patients after surgical treatment of breast cancer. The study included 100 patients with an average age of 59 years who had breast operations for breast cancer that included simple and radical mastectomies, quadrantectomies, local excision and sentinel node biopsy.…”