Ovechkin A M, Kukushkin M L, Gnezdilov A V, Reshetniak V K
Anesteziol Reanimatol. 1995 Mar-Apr(2):56-9.
Examinations of 72 patients with a history of amputation of the lower limb showed that preamputation pain may be transformed into phantom pain via "pain memory" mechanisms. This fact is confirmed by similarity of the verbal structure of preamputation pain and phantom pain syndrome, which are particularly expressed in the patients operated on under total anesthesia. At the same time, the share of patients considering phantom pain identical to preamputation pain is much lower among those operated on under prolonged perioperative epidural anesthesia, and no "pain memory" phenomena are observed in this group 6 months after surgery. Prolonged epidural anesthesia provides a pain-free period before surgery by disrupting the time relationship between nociceptive impulsation entry in the CNS structures and amputation, thus preventing fixation of 'pain experience' survived in the memory. The adequacy of intraoperative analgesia attained by prolonged epidural anesthesia plays the crucial role in prevention of realization of the "pain memory" effect.
对72例有下肢截肢病史的患者进行检查发现，截肢前疼痛可能通过“疼痛记忆”机制转化为幻肢痛。截肢前疼痛和幻肢痛综合征的语言结构相似性证实了这一事实，这在全身麻醉下接受手术的患者中尤为明显。与此同时，在长时间围手术期硬膜外麻醉下接受手术的患者中，认为幻肢痛与截肢前疼痛相同的患者比例要低得多，且该组在术后6个月未观察到“疼痛记忆”现象。长时间硬膜外麻醉通过破坏伤害性冲动进入中枢神经系统结构与截肢之间的时间关系，在手术前提供无痛期，从而防止“疼痛体验”在记忆中固定下来。长时间硬膜外麻醉所达到的术中镇痛充分性在预防“疼痛记忆”效应的实现中起着关键作用。
