title: Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta-analysis.
abstract: Preoperative administration of pharmacological substances, such as non-steroidal anti-inflammatory drugs or opioids, has been gaining acclaim as a preemptive measure to minimize postoperative pain. This systematic review and meta-analysis aimed at evaluating the effectiveness of this approach in adults undergoing surgical procedures. MEDLINE, EMBASE and the Cochrane Central Register were searched from inception through January 2015. Data from randomized placebo-controlled trials were screened, extracted and assessed for risk of bias according to The Cochrane Collaboration's Tool by two independent authors. The primary outcome measure was reduction in postoperative analgesic consumption during 24 h post surgery; effects were described as mean differences between the drug and placebo arms with corresponding 95% confidence intervals (CIs) and were pooled using random-effects models. Potential publication bias was tested using funnel plots and Egger's regression test for funnel plot asymmetry. Screened were 511 records, of which 39 were included in the final synthesis with data from 3172 patients. A significant reduction in postoperative analgesic consumption was observed using preoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs; 95% CI, -0.61 to -0.14; 31 comparisons), chiefly by the COX-2 inhibitors class (95% CI, -0.95 to -0.33; 13 comparisons). Significant reduction was also observed for gabapentin (95% CI, -1.60 to -0.38; 6 comparisons). No significant effects were observed using opioids, propionic acids or oxicam derivatives. WHAT DOES THIS REVIEW ADD?: Current analyses endorse the effectiveness of COX-2 inhibitors and gabapentin in reducing acute postoperative pain when administered preemptively presurgery. Such corroboration is not found for opioids and other NSAID classes.
authors.affiliation: Department of Neurology, Rambam Health Care Campus, Haifa, Israel.|Laboratory of Clinical Neurophysiology, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: R-R
authors.initials: RR
authors.lastname: Nir
authors.affiliation: Department of Neurology, Rambam Health Care Campus, Haifa, Israel.|Laboratory of Clinical Neurophysiology, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Nahman-Averbuch
authors.affiliation: Department of Neurology, Rambam Health Care Campus, Haifa, Israel.|Laboratory of Clinical Neurophysiology, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Moont
authors.affiliation: Department of Neurology, Rambam Health Care Campus, Haifa, Israel.|Laboratory of Clinical Neurophysiology, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Sprecher
authors.affiliation: Department of Neurology, Rambam Health Care Campus, Haifa, Israel.|Laboratory of Clinical Neurophysiology, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Yarnitsky
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D011292:Premedication
chemical_list: D000700:Analgesics