Wake Forest School of Medicine, Winston Salem, NC 27157, USA.
Anesthesiology. 2013 Jan;118(1):152-9. doi: 10.1097/ALN.0b013e318278cd21.
BACKGROUND: Physical injury, including surgery, can result in chronic pain; yet chronic pain following childbirth, including cesarean delivery in women, is rare. The mechanisms involved in this protection by pregnancy or delivery have not been explored. METHODS: We examined the effect of pregnancy and delivery on hypersensitivity to mechanical stimuli of the rat hindpaw induced by peripheral nerve injury (spinal nerve ligation) and after intrathecal oxytocin, atosiban, and naloxone. Additionally, oxytocin concentration in lumbar spinal cerebrospinal fluid was determined. RESULTS: Spinal nerve ligation performed at mid-pregnancy resulted in similar hypersensitivity to nonpregnant controls, but hypersensitivity partially resolved beginning after delivery. Removal of pups after delivery prevented this partial resolution. Cerebrospinal fluid concentrations of oxytocin were greater in normal postpartum rats prior to weaning. To examine the effect of injury at the time of delivery rather than during pregnancy, spinal nerve ligation was performed within 24 h of delivery. This resulted in acute hypersensitivity that partially resolved over the next 2-3 weeks. Weaning of pups resulted only in a temporary return of hypersensitivity. Intrathecal oxytocin effectively reversed the hypersensitivity following separation of the pups. Postpartum resolution of hypersensitivity was transiently abolished by intrathecal injection of the oxytocin receptor antagonist, atosiban. CONCLUSIONS: These results suggest that the postpartum period rather than pregnancy protects against chronic hypersensitivity from peripheral nerve injury and that this protection may reflect sustained oxytocin signaling in the central nervous system during this period.
背景:身体损伤,包括手术,会导致慢性疼痛;然而,产后(包括女性剖宫产)慢性疼痛很少见。参与这种妊娠或分娩保护的机制尚未被探索。
方法:我们研究了妊娠和分娩对大鼠后爪机械刺激超敏反应的影响,这些大鼠的后爪受到外周神经损伤(脊神经结扎)以及鞘内催产素、阿托西班和纳洛酮的影响。此外,还测定了腰椎脊髓脑脊液中的催产素浓度。
结果:在妊娠中期进行脊神经结扎导致与非妊娠对照组相似的超敏反应,但分娩后超敏反应部分缓解。分娩后去除幼仔可防止这种部分缓解。在断奶前,正常产后大鼠的脑脊液中催产素浓度较高。为了研究分娩时而不是妊娠时损伤的影响,在分娩后 24 小时内进行脊神经结扎。这导致急性超敏反应,在接下来的 2-3 周内部分缓解。幼仔断奶仅导致超敏反应暂时恢复。鞘内给予催产素可有效逆转幼仔分离后的超敏反应。鞘内注射催产素受体拮抗剂阿托西班可暂时阻断产后超敏反应的缓解。
结论:这些结果表明,产后而不是妊娠期可防止外周神经损伤后的慢性超敏反应,这种保护作用可能反映了在此期间中枢神经系统中催产素信号的持续存在。
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