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بِسْم الله الرحمن الرحيم
Preemptive Analgesia
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Terminology Preemptive vs.Preventive High intensity noxious stimuli
1.primary phase : surgical injury 2.secondary phase: inflammation Peripheral and central sensitization
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Peripheral sensitization
Activation and increase activity of nocicepptors due to inflammation Alterations in neurophysiological properties Trpv receptors
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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
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Drugs NSAIDS Intravenous opioids Intravenous ketamine
NMDA receptor antagonist: dextrometorphan Peripheral local anesthetics Caudal Epidural Gabapentin and pregabalin
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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
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