Preemptive analgesia: Moving beyond conventional strategies and confusing terminology

Trials of preemptive analgesia compare the effect of drugs administered bef ore injury with the same treatment administered after injury, whereas studi es of perioperative analgesia include comparisons of preinjury administrati on with no particular analgesic treatment at all. In contrast to earlier re ports, recent animal behavioral studies of persistent nociception and clini cal trials of preemptive analgesia using randomized, controlled protocols s trongly indicate that conventional treatments such as local anesthetics and opioids do not exhibit significant preemptive analgesic effects for postop erative pain. The direction of perioperative medicine must be shifted away from conventional preemptive analgesia studies, and towards (1) preemptive analgesia studies using novel treatment strategies; (2) perioperative analg esic strategies involving continuous administration of analgesics and anest hetics; and (3) a focus on clinical outcomes involving hospital stay, cost, and patient satisfaction.