Viel E, Bruelle P, Eledjam J J
Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Nimes.
Cah Anesthesiol. 1994;42(1):61-9.
The key-question, when dealing with preemptive analgesia, its to know whether an analgesic intervention coming before surgery is as efficient, more efficient or less efficient than the same intervention following surgery. Surgical tissular damaging leads to a dual phenomenon of peripheral and central sensitization. The result is a state of neuronal hyperexcitability, so-called "wind-up phenomenon", which could partially explain postoperative painful states. Peripheral mechanisms involve many factors, especially prostaglandins that could be blocked by NSAIDs. Central mechanisms and neuroplasticity are analyzed, insisting on inter and intracellular biochemical events. The role of excitatory amino-acid is explained, especially of glutamic acid and the NMDA (N-methyl-D-aspartate) receptor at the spinal level.
在处理超前镇痛时，关键问题在于了解术前进行的镇痛干预与术后进行相同干预相比，效果是相同、更好还是更差。手术造成的组织损伤会导致外周和中枢敏化的双重现象。结果是神经元出现过度兴奋状态，即所谓的“痛觉过敏现象”，这可以部分解释术后的疼痛状态。外周机制涉及许多因素，尤其是前列腺素，非甾体抗炎药可以阻断这些前列腺素。文中分析了中枢机制和神经可塑性，着重阐述了细胞间和细胞内的生化事件。解释了兴奋性氨基酸的作用，尤其是脊髓水平的谷氨酸和N-甲基-D-天冬氨酸（NMDA）受体的作用。
