Yaksh T L
Department of Anesthesiology, University of California, San Diego, La Jolla 92093.
Curr Opin Neurol Neurosurg. 1993 Apr;6(2):250-6.
Repetitive C afferent input evokes a facilitated state of processing that results in increased receptive fields and exaggerated responses to afferent input ("wind-up"). These phenomena underlie the behavioral phenomena of secondary hyperalgesia and this in turn is an important component of postoperative pain. The initiation of this facilitated component is not well blocked by even higher concentrations of volatile anesthetics, but it can be prevented by pretreatment with agents known to block afferent input (local anesthetics) or C-fiber transmitter release (opiates) or to act at one of several links to block a complex spinal cascade involving the N-methyl-D-aspartate receptor, nitric oxide synthase, and cyclooxygenase. These fundamental mechanisms promise to have an impact on the management of postoperative pain.
重复的C类传入输入引发一种促进性的处理状态，导致感受野增加以及对传入输入的反应增强（“wind-up”）。这些现象是继发性痛觉过敏行为现象的基础，而继发性痛觉过敏又是术后疼痛的一个重要组成部分。即使是更高浓度的挥发性麻醉剂也不能很好地阻断这种促进性成分的起始，但可以通过用已知能阻断传入输入的药物（局部麻醉剂）、C纤维递质释放的药物（阿片类药物）或作用于几个环节之一以阻断涉及N-甲基-D-天冬氨酸受体、一氧化氮合酶和环氧化酶的复杂脊髓级联反应的药物进行预处理来预防。这些基本机制有望对术后疼痛的管理产生影响。
