Suter M R, Siegenthaler A, Decosterd I, Ji R R
Pain Center, Department of Anesthesiology, University Hospital Center and University of Lausanne, 1011 Lausanne, Switzerland.
Anesthesiol Res Pract. 2011;2011:124898. doi: 10.1155/2011/124898. Epub 2011 Jul 12.
Peripheral and neuraxial nerve blockades are widely used in the perioperative period. Their values to diminish acute postoperative pain are established but other important outcomes such as chronic postoperative pain, or newly, cancer recurrence, or infections could also be influenced. The long-term effects of perioperative nerve blockade are still controversial. We will review current knowledge of the effects of blocking peripheral electrical activity in different animal models of pain. We will first go over the mechanisms of pain development and evaluate which types of fibers are activated after an injury. In the light of experimental results, we will propose some hypotheses explaining the mitigated results obtained in clinical studies on chronic postoperative pain. Finally, we will discuss three major disadvantages of the current blockade: the absence of blockade of myelinated fibers, the inappropriate duration of blockade, and the existence of activity-independent mechanisms.
外周和神经轴索阻滞在围手术期广泛应用。其减轻术后急性疼痛的价值已得到确立，但其他重要结局，如慢性术后疼痛、新近出现的癌症复发或感染，也可能受到影响。围手术期神经阻滞的长期影响仍存在争议。我们将综述在不同疼痛动物模型中阻断外周电活动作用的现有知识。我们将首先探讨疼痛发生的机制，并评估损伤后哪些类型的纤维被激活。根据实验结果，我们将提出一些假说，以解释在慢性术后疼痛临床研究中获得的缓解结果。最后，我们将讨论当前阻滞的三个主要缺点：对有髓纤维的阻滞不足、阻滞持续时间不合适以及存在与活动无关的机制。
