Katz J
Department of Psychology, Toronto Hospital, Canada.
Eur J Anaesthesiol Suppl. 1995 May;10:8-13.
Although some studies of pre-emptive analgesia have reported small reductions in post-operative pain or analgesic consumption in favour of pre-incisional vs. post-incisional or post-operative treatment, most have not demonstrated any benefit at all. This paper reviews recent evidence supporting the effectiveness of pre-emptive analgesia and discusses factors that may be responsible for the lack of consistent results. These factors include problems with the accepted definition of pre-emptive analgesia, the potential pre-emptive analgesic effects of other agents (e.g. opioids, nitrous oxide, pentobarbitone) used routinely as part of the general anaesthetic, the role of post-operative inflammation in initiating and enhancing a state of central sensitization, and the lack of a true placebo control condition. Given the constraints of clinical research and current standards of practice, it is unlikely that studies of pre-emptive analgesia using conventional analgesics or local anaesthetics will yield large reductions in post-operative pain or analgesic consumption. Extending the pre-emptive treatment well into the post-operative period using balanced, multimodal analgesia, may prolong the initial advantage conferred by the pre-operative blockade and possibly interfere with the development of long-lasting pain.
尽管一些关于超前镇痛的研究报告称，与切口后或术后治疗相比，切口前治疗在术后疼痛或镇痛药物消耗方面有小幅降低，但大多数研究根本没有显示出任何益处。本文回顾了支持超前镇痛有效性的最新证据，并讨论了可能导致结果不一致的因素。这些因素包括超前镇痛公认定义存在的问题、作为全身麻醉常规组成部分使用的其他药物（如阿片类药物、氧化亚氮、戊巴比妥）的潜在超前镇痛作用、术后炎症在引发和增强中枢敏化状态中的作用，以及缺乏真正的安慰剂对照条件。鉴于临床研究的限制和当前的实践标准，使用传统镇痛药或局部麻醉药进行超前镇痛的研究不太可能大幅降低术后疼痛或镇痛药物消耗。使用平衡的多模式镇痛将超前治疗延长至术后很长一段时间，可能会延长术前阻滞带来的初始优势，并可能干扰持续性疼痛的发展。
