Preemptive Analgesia and Local Anesthesia as a Supplement to General Anesthesia: A Review

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Preemptive Analgesia and Local Anesthesia as a Supplement to General Anesthesia: A Review
Anesthesia Progress
Volume 52, Issue 1 (Spring 2005)

Eliezer Kaufman, DMD*, Joel B. Epstein, DMD, MSD, FRDC(C)‹, Meir Gorsky, DMD·, Douglass L. Jackson, DMD, MS, PhD?, and Avishag Kadari, MD
* Department of Oral Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
‹ formerly Department of Oral Medicine, University of Washington, School of Dentistry, Seattle, Washington, currently Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois, Chicago, Illinois
· Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
? Department of Oral Medicine, University of Washington, School of Dentistry, Seattle, Washington; and Pediatric Anesthesia Unit, Department of Anesthesia and Intensive Care, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

General anesthesia (GA) and local anesthesia (LA) evolved on separate tracks. Procedures that could not be performed under LA were typically conducted under GA. Decoding of afferent linkage of peripheral noxious stimuli has provided important understanding that may change the way we traditionally treat surgical pain. In the 1980s, animal studies suggested that preemptive peripheral blocking of painful (nociceptive) stimuli to the central nervous system with regional anesthesia or LA and nonsteroidal analgesics could be beneficial in attenuating postoperative pain. Clinical studies based on this knowledge suggest combining LA with GA, and perhaps non-steroidal analgesics with or without narcotics, to reduce the severity of postoperative pain. General anesthetics can be given in lower minimal alveolar concentration when combined with LA, and recovery characteristics are superior. Increasing evidence suggests that the combined use of GA and LA may reduce the afferent barrage of surgery, and that preemptive analgesia may reduce postoperative pain and should be used in patient care. This article reviews the evidence supporting the combined use of LA or analgesics with GA or sedation to provide improved pain management after surgery.

Keywords: General anesthesia, Local anesthesia, Nerve block, Analgesics, Postoperative pain, Pain

Received: January 23, 2003; Accepted: July 2, 2004

DOI: 10.2344/0003-3006(2005)52[29:PAALAA]2.0.CO;2

*Address correspondence to Prof Eliezer Kaufman, Dental Intensive Care Center, Department of Oral Medicine, The Hebrew University-Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, Israel.

© 2007 The American Dental Society of Anesthesiology