Expert opinion on pharmacotherapy
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The pain that accompanies surgical procedures remains prevalent and is an aspect of the perioperative experience that generates the greatest concern for patients about to undergo surgery. There is also a growing recognition of the extent that acute painful experiences can lead to longer-term painful consequences, even when tissue healing appears to be complete. The neurobiologic basis of this has been partially elucidated. ⋯ Acute perioperative pain is an ideal setting for the use of pre-emptive analgesic techniques because the timing of noxious stimuli is known in advance and surgical sensitisation of the nervous system is ongoing despite adequate levels of general anaesthesia with volatile anaesthetics. The relevant neurobiology of pain, reviewed in this article, is the basis for advocating an aggressive, multimodal, pre-emptive approach to acute pain therapy throughout the entire perioperative period. A growing body of outcome studies demonstrates the long-term efficacy of this approach.