الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Aim of the work
1- Does opioid have a preemptive effect if given pre operatively?
2- Do the different opioid receptors have different effects (µ agonist “Fentanyl” versus k agonist “Nalbuphine”)?
3- Does the change of the route of administration associated with differences in the effects (e.g. IV versus Epidural routes)?
Conclusion
Some support has emerged in favor of the concept of preemptive analgesia, but a number of clinical studies have found no support, most likely due to the use of study designs that have made it difficult to find any reliable answers.
Appropriate pre injury treatment can reduce postoperative pain and hyperalgesia. But this preemptive analgesia should be made in advance of pain and should continue to prevent any ongoing sensitization from the injured tissue during and after surgery until wound healing is well established.
Any method of postoperative pain relief must meet three basic criteria: effectiveness (i.e. potency and timing), safety (i.e. the simplest non invasive route of administration) and feasibility.