This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Gordon, S. M. Articles by Dionne, R. A. Search for Related Content PubMed PubMed Citation Articles by Gordon, S. M. Articles by Dionne, R. A. Related Collections Surgery Pain

---

PAIN MEDICINE

Attenuation of Pain in a Randomized Trial by Suppression of Peripheral Nociceptive Activity in the Immediate Postoperative Period

Sharon M. Gordon, DDS MPH^*, Jaime S. Brahim, DDS MS^*, Ronald Dubner, DDS PhD, Linda M. McCullagh, RN MPH, Christine Sang, MD MPH, and Raymond A. Dionne, DDS PhD^*

*National Institute of Dental and Craniofacial Research, Bethesda, Maryland; University of Maryland, School of Dentistry, Baltimore, Maryland; Department of Nursing, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland; and Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts

Address correspondence and reprint requests to Dr. Raymond A. Dionne, 10 Center Drive, Room 1N-117, Bethesda, MD 20892-1191. Address e-mail to raymond.dionne{at}nih.gov

Peripheral neuronal barrage from tissue injury produces central nervous system changes that contribute to the maintenance of postoperative pain. The therapeutic approaches to blocking these central changes remain controversial, because previous studies have not differentiated presurgical interventions from those administered after tissue injury, yet before pain onset. In this study, we evaluated the relative contributions of blockade of nociceptive input during surgery or during the immediate postoperative period on pain suppression. Subjects were randomly allocated to one of four groups: preoperative 2% lidocaine, postoperative 0.5% bupivacaine, both, or placebo injections. General anesthesia was induced and third molars extracted. Pain was assessed over 4 h and at 24 and 48 h. The ß-endorphin in blood samples increased twofold during surgery, which is indicative of activation of the peripheral nociceptive barrage in response to painful stimuli. Pain was decreased in the immediate postoperative period in the bupivacaine groups, whereas it increased in the lidocaine group over time. Pain intensity was less 48 h after surgery in the groups whose postoperative pain was blocked by the administration of bupivacaine, but no effect was demonstrated for the preoperative administration of lidocaine alone. These results in the oral surgery pain model suggest that minimizing the peripheral nociceptive barrage during the immediate postoperative period decreases pain at later time periods. In contrast, blocking the intraoperative nociceptive barrage does not appear to contribute significantly to the subsequent reduction in pain.

IMPLICATIONS: Suppression of postoperative pain immediately after surgery attenuates the pain experienced 1 to 2 days after surgery. These findings suggest that pain after minor surgery can be prevented by blocking the development of pain processes that amplify pain for days after surgery.

This article has been cited by other articles:

				S. M. Gordon, B. P. Chuang, X. M. Wang, M. A. Hamza, J. S. Rowan, J. S. Brahim, and R. A. Dionne The Differential Effects of Bupivacaine and Lidocaine on Prostaglandin E2 Release, Cyclooxygenase Gene Expression and Pain in a Clinical Pain Model Anesth. Analg., January 1, 2008; 106(1): 321 - 327. [Abstract] [Full Text] [PDF]

				I. Kissin Preemptive Analgesia at the Crossroad Anesth. Analg., March 1, 2005; 100(3): 754 - 756. [Full Text] [PDF]

				S. M. GORDON and R. A. DIONNE The integration of clinical research into dental therapeutics: The role of the astute clinician J Am Dent Assoc, November 1, 2004; 135(11): 1537 - 1542. [Abstract] [Full Text] [PDF]