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2013 ; 29
(4
): 213-22
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Perioperative interventions to reduce chronic postsurgical pain
#MMPMID23463498
Carroll I
; Hah J
; Mackey S
; Ottestad E
; Kong JT
; Lahidji S
; Tawfik V
; Younger J
; Curtin C
J Reconstr Microsurg
2013[May]; 29
(4
): 213-22
PMID23463498
show ga
Approximately 10% of patients following a variety of surgeries develop chronic
postsurgical pain. Reducing chronic postoperative pain is especially important to
reconstructive surgeons because common operations such as breast and limb
reconstruction have even higher risk for developing chronic postsurgical pain.
Animal studies of posttraumatic nerve injury pain demonstrate that there is a
critical time frame before and immediately after nerve injury in which specific
interventions can reduce the incidence and intensity of chronic neuropathic pain
behaviors-so called "preventative analgesia." In animal models, perineural local
anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic
gabapentin, systemic tricyclic antidepressants, and minocycline have each been
shown to reduce pain behaviors days to weeks after treatment. The translation of
this work to humans also suggests that brief perioperative interventions may
protect patients from developing new chronic postsurgical pain. Recent clinical
trial data show that there is an opportunity during the perioperative period to
dramatically reduce the incidence and severity of chronic postsurgical pain. The
surgeon, working with the anesthesiologist, has the ability to modify both early
and chronic postoperative pain by implementing an evidence-based preventative
analgesia plan.