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PAIN MEDICINE

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

Cliff K.-S. Ong, DDS^*, Philipp Lirk, MD, Robin A. Seymour, PhD, and Brian J. Jenkins, MD

*Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore; Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Medical University of Innsbruck, Innsbruck, Austria; Department of Restorative Dentistry, Faculty of Dentistry, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom; and Department of Anaesthetics and Intensive Care Medicine, College of Medicine, University of Wales, United Kingdom

Address correspondence and reprint requests to Cliff K. S. Ong, DDS, 435 Orchard Rd., Ste. 11-02, Wisma Atria, Singapore 238877. Address e-mail to cliffong{at}pacific.net.sg.

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.

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