1. Pain facts 5 Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio) Mahatma Gandhi medical college and research institute, puducherry – India

2. Preemptive analgesia analgesia is achieved by use of pre- emptive analgesic which is initiated before surgery and continued throughout the perioperative period.

3. Definition Initiating an analgesic regimen before the onset of the noxious stimulus to prevent central as well as peripheral sensitization and limit the subsequent pain experience is called pre- emptive analgesic

4. Example Herniotomy Method 1 – presurgical infiltration and GA Method 2 – GA and postoperative infiltration

5. Three facts Start before surgery Prevents sensitization because of incision Prevents sensitization because of post operative inflammation.

6. Injury and changes

7. Methods and use Definition Continued use Study parameters

8. All methods – comparison

9. Kundra et al Laminectomy, Epidural morphine before and after surgery Better postop analgesia

10. Kundra et al Paediatric hernias Preemptive caudal bupivacaine And GA Postop caudal bupivacaine And GA preemptive better

11. Chronic pain - preemptive ok- yet Phantom pain Chronic incision pain Only few studies

12. JOACP 2009: 25(2) 214-216 ACUPUNCTURE – A PREEMPTIVE ANALGESIC TECHNIQUE Dr.S.Parthasarathy Dr.M.Ravishankar

13. Thank you all