**3. Management of POP in plastic surgery**

The POP approach should be started before surgery. This stage, known as pre-emptive analgesia, is based on preventing the development of spinal hyperexcitability and behaviors related to pain. The measures to prevent POP are basic and very simple in plastic surgery. During the initial evaluation, the anesthesiologist must gain the patient's trust by establishing a deep empathic relationship. The usual questioning and physical examination are not enough; the expectations of each patient must be known, and the reasons for their plastic surgery, and their personal and work environment are issues that facilitate this patient-anesthesiologist relationship. Preemptive analgesia includes the administration of an analgesic technique or drug with the aim of attenuating postoperative pain, hyperalgesia, and allodynia. In this phase, there is a wide range of possibilities, and several drugs must be used simultaneously. The preoperative combination of an NSAID, magnesium, ketamine, pregabalin, and an analgesic such as metamizole (dipyrone) or acetaminophen produces spectacular analgesic results [18–21].
