The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A Meta-Analysis

Abstract

Whether preemptive analgesic interventions are more effective than conventional regimens in managing acute postoperative pain remains controversial. We systematically searched for randomized controlled trials that specifically compared preoperative analgesic interventions with similar postoperative analgesic interventions via the same route. The retrieved reports were stratified according to five types of analgesic interventions: epidural analgesia, local anesthetic wound infiltration, systemic N-methyl-d-aspartic acid (NMDA) receptor antagonists, systemic nonsteroidal antiinflammatory drugs (NSAIDs), and systemic opioids. The primary outcome measures analyzed were the pain intensity scores, supplemental analgesic consumption, and time to first analgesic consumption. Sixty-six studies with data from 3261 patients were analyzed. Data were combined by using a fixed-effect model, and the effect size index (ES) used was the standardized mean difference. When the data from all three outcome measures were combined, the ES was most pronounced for preemptive administration of epidural analgesia (ES, 0.38; 95% confidence interval [CI], 0.28-0.47), local anesthetic wound infiltration (ES, 0.29; 95% CI, 0.17-0.40), and NSAID administration (ES, 0.39; 95% CI, 0.27-0.48). Whereas preemptive epidural analgesia resulted in consistent improvements in all three outcome variables, preemptive local anesthetic wound infiltration and NSAID administration improved analgesic consumption and time to first rescue analgesic request, but not postoperative pain scores. The least proof of efficacy was found in the case of systemic NMDA antagonist (ES, 0.09; 95% CI, -0.03 to 0.22) and opioid (ES, -0.10; 95% CI, -0.26 to 0.07) administration, and the results remain equivocal.

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

“…However, there is no current evidence supporting any advantage for preemptive analgesia with opioids after two detailed reviews across a broad range of surgical procedures [23,24]. Our findings of a lack of preemptive analgesia with oral opioid for UAE support the findings of these reviews.…”

“…Epidural analgesia appears to have the greatest advantage as a preemptive analgesic because it provides reduced PI, reduces the need for supplemental analgesia and prolongs the time to rescue analgesia [24]. Epidural analgesia has been researched in the context of UAE with promising results but only in case series [17,18] and needs to be evaluated in the context of a prospective randomized blinded study compared to morphine PCA, which is currently the most researched therapy and has been shown to be a useful control.…”

Association between Acute Postoperative Pain and Recovery of Independent Walking Ability after Surgical Treatment of Hip Fracture

“…[29][30][31][32] Arinzon et al reported that adequate acute pain control and family support were associated with better functional outcomes among hip fracture patients. 33) A study on chronic pain has described the sense of helplessness and isolation reported by patients in whom pain is not well controlled.…”

Why anesthesiologists need to care about the way chronic pain is managed

“…The evidence for preemptive NMDA antagonists is equivocal, and there is lack of evidence that preemptive opioid administration has any additional effect. 17 …”

“…Les données probantes appuyant l'utilisation d'antagonistes du NMDA sont équivoques, et nous manquons de données probantes étayant que l'administration préventive d'opioïdes ait un effet additionnel quelconque. 17 Est-ce que le type d'anesthésie est important?…”