Preempting the Memory of Pain

Powerful scientific, social, and economic forces are changing the practice of medicine and surgery. Surgical trauma, particularly during major procedures that involve extensive incisions and resection, has short-term and long-term consequences. Such sequelae, evident even with the most skillful surgical technique, include pain, immobility, pulmonary dysfunction,¹ hypercoagulability, and stress hormone secretion to produce tissue breakdown or water retention.² These undesired responses to tissue injury not only impair postoperative quality of life but also impede rehabilitation, increase the likelihood of complications, and raise the direct and indirect costs of care. Therefore, a convergence of motives has emerged among patients and families who wish to minimize perioperative pain and suffering, surgeons and anesthesiologists who desire an uncomplicated and speedy convalescence, and administrators who seek to minimize the costs of care.³ This convergence has yielded impressive progress in minimally invasive surgical techniques. Cholecystectomy, for example, is now performed more frequently through a laparoscopic approach than an open incision,⁴ and each month surgeons witness the "closing" of yet another previously "open" procedure (eg, herniorrhaphy, colectomy, thoracotomy, coronary artery bypass grafting).