90 Preemptive multimodal analgesia for postoperative pain management: a randomized controlled trial- case study

Background and Aims PREEMPTIVE analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input, which amplifies postoperative pain. The concept of preemptive analgesia was formulated by Crile 1 at the beginning of the previous century on the basis of clinical observations. Purpose: To assess the eficacy of a novel preemptive multimodal analgesic regimen for reducing postoperative pain and complications. Methods To give Pregabalin (Lyrica) 75 mg 2 hrs or more before surgery then 75 mg QHS for 3days postoperative, to be reassessed by APS team if extension needed. No valium with lyrica. To add Celecoxib (if not contraindicated) 200–400 mg tablet 1 hour before surgery then 200 mg BID for 3 days only. Ranitidine 150 mg BID could be added. Surgical site-specific regional analgesia whenever possible. PCA morphine can be used if indicated and as a backup plan for breakthrough pain. Then post.op, Pregabalin, Celecoxib, Solpadeine 2 tablets Q6hrs or TID. Results 30 patients came calm pre-op., smooth for GA, RA blocks, other 10 patients little anxious. All patients examined second day; 30 patients had smooth sleep, no pain after regional blocks, needed PCA morphine 1–5 mg (10 patients). Other 10 patients continued only on oral tablets. Conclusions **The new preemptive multimodal analgesic combination is safe and effective postoperative. **may reduce severity of adverse effects of the opioid. ** Regular review, follow up of patients postoperative by APS team for 4 days is mandatory.