Pre-emptive analgesia reduces postoperative pain experience following oral day case surgery

Abstract

Modern concepts of acute pain generation emphasize that surgical trauma may lead to hyperexcitability of dorsal horn sensory neurones, resulting in amplification and prolongation of postoperative pain; these effects may be reduced or eliminated by pre-emptive analgesics. Thirty patients undergoing day case general anaesthetic surgical removal of impacted mandibular third molar teeth were entered into a double-blind, placebo-controlled, randomized study and instructed on the use of the visual analogue scale (VAS) for pain assessment. Patients received one of three test solutions (tramadol 100 mg, ketorolac 30 mg or placebo) intravenously after anaesthetic induction and VAS scores were measured every 30 min for 2.5 h postoperatively. Results confirmed that preoperative administration of tramadol reduced pain experience postoperatively, compared with placebo; comparison with preoperative ketorolac revealed reduced pain scores during the later postoperative period, fewer patients requiring additional analgesics in the initial recovery period and a longer time before first dose 'escape analgesia'. © 1995.