Buvanendran Asokumar, Ali Amjad, Stoub Travis R, Berger Richard A, Kroin Jeffrey S
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois 60612, USA.
Anesth Analg. 2007 Dec;105(6):1784-6, table of contents. doi: 10.1213/01.ane.0000270206.30333.cb.
It is not known how different analgesic regimes affect the brain when reducing postoperative pain. We performed positron emission tomography (PET) scans on a 69-yr-old woman in the presence of moderate postoperative pain and then with epidural analgesia producing complete analgesia, during the first 2 days after total knee arthroplasty. Day 2 postsurgery PET scan data (no pain with epidural analgesia) were subtracted from Day 1 postsurgery PET scan data (time of moderate pain without epidural analgesia) to determine the brain regions activated. Postsurgical pain was associated with increased activity in the contralateral primary somatosensory cortex. Other brain regions showing increased postsurgical activity were the contralateral parietal cortex, bilateral pulvinar and ipsilateral medial dorsal nucleus of the thalamus, contralateral putamen, contralateral superior temporal gyrus, ipsilateral fusiform gyrus, ipsilateral posterior lobe, and contralateral anterior cerebellar lobe. This study demonstrates the feasibility of evaluating the central processing of acute postoperative pain using PET.
目前尚不清楚不同的镇痛方案在减轻术后疼痛时如何影响大脑。我们在全膝关节置换术后的头两天，对一名69岁女性在中度术后疼痛状态下以及硬膜外镇痛产生完全镇痛效果时进行了正电子发射断层扫描（PET）。用术后第1天（无硬膜外镇痛的中度疼痛时）的PET扫描数据减去术后第2天（硬膜外镇痛无疼痛时）的PET扫描数据，以确定被激活的脑区。术后疼痛与对侧初级体感皮层的活动增加有关。术后活动增加的其他脑区包括对侧顶叶皮层、双侧丘脑枕和同侧丘脑内侧背核、对侧壳核、对侧颞上回、同侧梭状回、同侧后叶以及对侧小脑前叶。这项研究证明了使用PET评估急性术后疼痛的中枢处理过程的可行性。
