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Preemptive, Preventive, Multimodal Analgesia: What Do They Really Mean?

Rosero, Eric B. MD, MSc; Joshi, Girish P. MBBS, MD, FFARCSI

Plastic and Reconstructive Surgery: October 2014 - Volume 134 - Issue 4S-2 - p 85S–93S
doi: 10.1097/PRS.0000000000000671
Special Topics: Original Articles

Summary: To improve postoperative pain management, several concepts have been developed, including preemptive analgesia, preventive analgesia, and multimodal analgesia. This article will discuss the role of these concepts in improving perioperative pain management. Preemptive analgesia refers to the administration of an analgesic treatment before the surgical insult or tissue injury. Several randomized clinical trials have, however, provided equivocal evidence regarding the benefits of preincisional compared with postincisional analgesic administration. Current general consensus, therefore, indicates that use of preemptive analgesia does not translate into consistent clinical benefits after surgery. Preventive analgesia is a wider concept where the timing of analgesic administration in relation to the surgical incision is not critical. The aim of preventive analgesia is to minimize sensitization induced by noxious stimuli arising throughout the perioperative period. Multimodal analgesia consists of the administration of 2 or more drugs that act by different mechanisms for providing analgesia. These drugs may be administered via the same route or by different routes. Thus, the aim of multimodal analgesia is to improve pain relief while reducing opioid requirements and opioid-related adverse effects. Analgesic modalities currently available for postoperative pain control include opioids, local anesthetic techniques [local anesthetic infiltration, peripheral nerve blocks, and neuraxial blocks (epidural and paravertebral)], acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2-specific inhibitors as well as analgesic adjuncts such as steroids, ketamine, α-2 agonists, and anticonvulsants.

Dallas, Tex.

From the Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center.

Received for publication March 18, 2014; accepted July 15, 2014.

Disclosure: Dr. Joshi has received honoraria from Pfizer, Baxter, Pacira, Cadence, and Mylan. Dr. Rosero has no financial conflict of interest related to this article. This work was supported entirely by internal funds from the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas.

Girish P. Joshi, MBBS, MD, FFARCSI, Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390–9068,

©2014American Society of Plastic Surgeons