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The efficacy of preemptive analgesia for acute postoperative pain management: A meta-analysis

Lookup NU author(s): Emeritus Professor Robin Seymour

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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. © 2005 by the International Anesthesia Research Society.

Publication metadata

Author(s): Ong CK-S, Lirk P, Seymour RA, Jenkins BJ

Publication type: Article

Publication status: Published

Journal: Anesthesia and Analgesia

Year: 2005

Volume: 100

Issue: 3

Pages: 757-773

Print publication date: 01/03/2005

ISSN (print): 0003-2999

ISSN (electronic): 1526-7598

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1213/01.ANE.0000144428.98767.0E

DOI: 10.1213/01.ANE.0000144428.98767.0E

PubMed id: 15728066

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