Rivat Cyril, Bollag Laurent, Richebé Philippe
aInstitut des Neurosciences de Montpellier, INSERM, Montpellier, France bUniversity of Washington Medical Center, seattle, Washington, USA cUniversity of Montreal/Université de Montréal UDM, Montral, Quebec, Canada.
Curr Opin Anaesthesiol. 2013 Oct;26(5):621-5. doi: 10.1097/01.aco.0000432511.08070.de.
The aim of the present review is to describe how regional anaesthesia might oppose neuronal changes that surgery and opioids cause in the central nervous system to block both pain sensitization and chronicization following surgery. This might help anaesthesiologists to better understand the impact of their practice on the development of postoperative chronic pain.
Even though there are more evidences from animals and clinical trials showing that regional anaesthesia might impact the acute pain/hyperalgesia and chronic postsurgical pain, the controversy on how and when to use regional anesthesia to avoid chronic pain persists. Animal studies brought only a very partial answer on what to do in our daily clinical practice. Clinical studies were performed in different types of surgery with various protocols so that a strong conclusion on whether or not using regional anesthesia might benefit the patient to decrease the risk of postoperative chronic pain remains unclear. Studies performed with neuraxial anaesthesia seem to bring better evidences than those with nerve blocks. Future studies will have to specifically evaluate acute hyperalgesia and postoperative chronic pain and not only the classical pain scores and analgesic consumption to bring us the answer we all need.
Regional anaesthesia is able to reduce postoperative acute hyperalgesia and long-term chronic pain by decreasing pain sensitization induced by the surgery itself, and intraoperative use and opioid-induced hyperalgesia. Nevertheless, clinical studies on neuraxial anaesthesia and nerve blocks did not bring so far a strong conclusion to this question, and further better designed studies are necessary.
本综述旨在描述区域麻醉如何对抗手术和阿片类药物在中枢神经系统中引起的神经元变化，以阻断术后疼痛敏化和慢性化。这可能有助于麻醉医生更好地理解其操作对术后慢性疼痛发展的影响。
尽管动物实验和临床试验有更多证据表明区域麻醉可能影响急性疼痛/痛觉过敏和术后慢性疼痛，但关于如何以及何时使用区域麻醉来避免慢性疼痛的争议仍然存在。动物研究仅对我们日常临床实践中的做法给出了非常片面的答案。临床研究在不同类型的手术中采用了各种方案进行，因此关于使用区域麻醉是否可能使患者受益以降低术后慢性疼痛风险的有力结论仍不明确。与神经阻滞相比，椎管内麻醉的研究似乎提供了更好的证据。未来的研究将必须专门评估急性痛觉过敏和术后慢性疼痛，而不仅仅是经典的疼痛评分和镇痛药物消耗量，才能给我们带来我们都需要的答案。
区域麻醉能够通过减少手术本身、术中使用阿片类药物以及阿片类药物诱导的痛觉过敏所引起的疼痛敏化，来减轻术后急性痛觉过敏和长期慢性疼痛。然而，到目前为止，关于椎管内麻醉和神经阻滞的临床研究尚未对此问题得出有力结论，还需要进一步设计更完善的研究。
