Year : 2017  |  Volume : 2  |  Issue : 4  |  Page : 144-152

Preemptive analgesia in orthopedic surgery: a literature review

1 High Specialty Unit “Dr Victorio De La Fuente Narvaez”, Mexican Social Security Institute, Mexico City, Mexico
2 Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado ISSSTE, Mexico City, Mexico

Correspondence Address:
Juan Lopez Valencia
High Specialty Unit “Dr Victorio De La Fuente Narvaez”, Mexican Social Security Institute, Mexico City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2542-4157.219377

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Pain after surgery is a maladaptive response. Acute postoperative pain is an important predictive factor for chronic post-surgical pain, which is observed in 10–65% of patients after surgery. Therefore controlling pain after surgery is very important. Reducing postoperative pain will result in more patient satisfaction, less complications due to immobility and decreased hospitalization periods. In this review, the use of preemptive analgesia in orthopedic surgery with a great variety of medications and interventions is examined. A search with the key words of “preemptive analgesia”, “orthopedic surgery” and “post-surgical pain” was conducted in online database PubMed, EBSCO, Elsevier (ClinicalKey), SpringerLink and OVID. Then selected articles from 5 years relevant with the application of preemptive analgesia in orthopedic surgery were analyzed. Finally we show some interventions with the outcomes and the challenges and new investigations suggested. The results showed that preemptive analgesia can be from regional blockade and local wound infiltration before incision to application of oral or intravenous medication before beginning surgery (NSAIDs, Gabapentin, Pregabalin, Dextromethorphan, Melatonin, Multimodal and Opioids) and the new approaches like transcutaneous electrical nerve stimulation (TENS). Preemptive analgesia has an important role in diminishing the pain rate in the post-surgical state, lowering pain medication intake and improving the patient satisfaction and early mobilization.

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