Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. Suchpre-emptive analgesia is the theoretical basis of the clinical experience cited above. This experimental knowledge has clinical applications in the field of postoperative analgesia-which, as is well known, is the Cinderella of anaesthesia. Al-thoughs sound knowledge of the methods is available, postoperative pain relief is very often inadequate. because of organizational difficulties. Pre-emptive analgesia reduces the frequency and intensity of postoperative pain. Infiltration of the surgical incision with local anaesthetics, regional blockades, and spinal and epidural analgesia, all performed preoperatively, and also the administration of analgesies with the premedication, produce postoperative analgesia lasting longer than the known duration of any of these alone. The efficiency of these methods has been scientifically proved during recent years. Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.

译文

疼痛预防是临床麻醉的日常经验。现在有相当多的实验证据表明,短期伤害性刺激会唤起中枢神经系统的持久兴奋状态。这种兴奋状态可以通过相对小剂量的麻醉剂 (局部麻醉剂,阿片类药物) 在很大程度上预防。这种先发制人的镇痛是上述临床经验的理论基础。这些实验知识在术后镇痛领域具有临床应用,众所周知,这是麻醉的灰姑娘。尽管对该方法有充分的了解,但术后疼痛缓解往往不足。因为组织困难。先发制人镇痛可降低术后疼痛的频率和强度。术前均进行了局部麻醉剂,区域封锁以及脊柱和硬膜外镇痛的手术切口浸润,以及术前使用镇痛药的给药,可产生的术后镇痛持续时间长于已知的任何一种。近年来,这些方法的有效性已得到科学证明。先发制人镇痛在门诊手术以及常规临床麻醉中都是有利的,并且已被证明可有效预防幻肢疼痛。关于先发制人镇痛的性质和临床应用的许多问题仍未得到解答。但是,它的易用性和预防疼痛的明显临床优势意味着它应该在日常麻醉实践中占有一席之地。

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