Penn Researchers Strike Post-Surgical Pain Before It Starts With Preemptive Medication

April 07, 1998

(Philadelphia, PA) -- Post-operative pain can be vastly decreased by beginning pain treatment before surgery. Researchers at the University of Pennsylvania Medical Center have found that preemptive analgesia -- delivering pain medication to patients before surgery -- results in significant pain reduction long afterward. This confirms preliminary findings presented at the 1996 American Society of Anesthesiologists' annual meeting. The complete study appears in the April 8 issue of the Journal of the American Medical Association.

The rationale behind the use of preemptive analgesia is to stop pain from starting by blocking the nervous system's usual response to pain. The trauma from a surgical incision may cause the nerves in the spinal cord to "wind up" which leads to heightened sensitivity and enduring pain after surgery. Allan Gottschalk, MD, PhD, principal investigator and assistant professor of anesthesia, explains, "With preemptive analgesia we can prevent the sensitizing reaction to the surgical incision, thereby reducing post-surgical pain in the hospital and well after the patient returns home."

Dr. Gottschalk and his team of researchers studied 90 men scheduled for radical prostatectomies, the complete removal of the prostate gland for the treatment of prostate cancer. They divided the men into three groups: patients receiving a preemptive epidural narcotic or a local anesthetic prior to surgery and a group who did not receive any analgesia before surgery. All patients were given a standard general anesthetic and aggressive post-operative epidural analgesia.

Despite aggressive post-operative pain management for all patients, those who received preemptive analgesia reported thirty-three percent (33%) less pain throughout their hospitalization than those who did not receive pain medication before surgery. Telephone surveys conducted approximately three, five, and nine weeks after discharge revealed that eighty-six percent (86%) of the preemptive analgesia group were pain-free at nine weeks compared to forty-seven percent (47%) of the patients who received none. Moreover, those who were given preemptive pain killers were more active three and a half weeks after surgery.

Traditionally, post-operative pain is treated by administering analgesics after surgery has been performed. "Preemptive analgesia allows us to intervene early," says David S. Smith, MD, PhD, co-principal investigator and associate professor of anesthesia. "Instead of taking a reactive approach, we can take preventive measures against pain before surgery starts."

"The use of preemptive analgesia has resulted in major improvements in patient recovery and long-term reduction of pain after surgery," according to Dr. Gottschalk. "This adds to a number of recent studies which clearly demonstrate that what anesthesiologists do on the day of surgery can have an important impact on patients' lives long after they leave the operating room."

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Editor's notes: Dr. Gottschalk can be reached directly by calling (215) 662-3729; Dr. Smith can be reached directly by calling (215) 662-3722. Select patients are also available for interview upon request.

University of Pennsylvania School of Medicine

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