Fletcher D
Département d'anesthésie-réanimation, hôpital Bicêtre, France.
Ann Fr Anesth Reanim. 1998;17(6):622-32. doi: 10.1016/s0750-7658(98)80045-2.
The pre-emptive analgesia concept suggests that pre-administration of analgesics may enhance the efficacy of these drugs. This review has selected the data from the literature according to two types of methodological criteria: Sackett's criteria, and those specific of pre-emptive analgesia studies. Infiltration, spinal and peripheral nerve blocks using local anaesthetic drugs do not seem to produce pre-emptive analgesia. The few positive results have limited clinical significance. The results concerning opioids are contradictory and the clinical significance is limited. Preoperative oral administration of non steroidal anti-inflammatory drugs (NSAIDs) offers no benefit. Intravenous pre-administration has a limited advantage, but enhances perioperative bleeding. Ketamine, an NMDA receptor antagonist, may have some pre-emptive analgesic properties according to the few studies available. In conclusion, pre-administration of analgesic drugs represents the usual strategy for the anaesthesiologist (spinal or peripheral block, infiltration, opioids). In other cases (NSAIDs, ketamine), pre-administration represents a change in usual practice. This is not justified for NSAIDs; NMDA receptor antagonists may offer an interesting research area. Data concerning pre-emptive analgesia for chronic pain syndrome such as phantom limb pain are quite limited.
超前镇痛概念表明，预先给予镇痛药可能会增强这些药物的疗效。本综述根据两种方法学标准从文献中选取数据：萨克特标准以及超前镇痛研究的特定标准。使用局部麻醉药物进行浸润、脊髓和周围神经阻滞似乎不会产生超前镇痛效果。少数阳性结果的临床意义有限。关于阿片类药物的结果相互矛盾，临床意义也有限。术前口服非甾体抗炎药（NSAIDs）并无益处。静脉预先给药有一定局限性，且会增加围手术期出血。根据现有少数研究，NMDA受体拮抗剂氯胺酮可能具有一些超前镇痛特性。总之，预先给予镇痛药是麻醉医生的常用策略（脊髓或周围阻滞、浸润、阿片类药物）。在其他情况下（NSAIDs、氯胺酮），预先给药代表了常规做法的改变。NSAIDs这样做并无道理；NMDA受体拮抗剂可能提供一个有趣的研究领域。关于慢性疼痛综合征（如幻肢痛）超前镇痛的数据相当有限。
