A preemptive strike before surgery.

Administering pain medication prior to surgery helps patients long after they return home from the hospital. The idea behind preemptive analgesia is to head off pain by blocking the central nervous system's response before the surgery occurs. "If you stub your toe, portions of the foot might hurt for days because the blow sensitizes that part of the nervous system," explains Allan Gottschalk, an anesthesiologist at the University of Pennsylvania School of Medicine, Philadelphia. "The same thing happens when you have surgery. Preemptive analgesia decreases the sensitization that occurs with the surgical incision."

The technique reduces postsurgical pain not only during hospitalization, but also weeks after patients return home, his study showed. Ninety men scheduled for radical prostatectomies (the complete surgical removal of the prostate gland) were assigned randomly to one of three groups: no preemptive analgesia, preemptive analgesia with a narcotic (fentanyl), and preemptive analgesia with a local anesthetic (bupivacaine).

Every patient received an epidural catheter, a thin plastic tube inserted into the epidural space surrounding the spinal cord, plus a standard general anesthetic. Only those in the preemptive analgesia groups received pain medication through...