1. بِسْم الله الرحمن الرحيم
Preemptive
Analgesia

2. Terminology Preemptive vs.Preventive High intensity noxious stimuli
1.primary phase : surgical injury
2.secondary phase: inflammation
Peripheral and central sensitization

3. Peripheral sensitization
Activation and increase activity of nocicepptors due to inflammation
Alterations in neurophysiological properties
Trpv receptors

4. Central sensitization
donec quis nunc
excitatory neurotransmitter at the spinal cord ; hyperalgesia and allodynia
early phase: glutamate receptor phosphorylation and ion channels properties
second phase: transcription changes and new protein formation

5. Drugs NSAIDS Intravenous opioids Intravenous ketamine
NMDA receptor antagonist: dextrometorphan
Peripheral local anesthetics
Caudal
Epidural
Gabapentin and pregabalin

6. Challenges Duration of the noxious inflammatory state
Surgical techniques
Use of premeditation or intraoperative analgesic adjuvants
Not complete standards: pain scale and opioid consumption
Completely noxious blocking is not possible: T4 to S5