局麻药在术后慢性疼痛预防及治疗中的作用

Effect of local anesthetics on the prevention and treatment of chronic post-surgical pain

尽管疼痛的发生机制正在被逐步深入地研究,疼痛规范化管理的观念也在不断地强化,术后慢性疼痛较高的发生率仍然是临床工作中不可忽视的难题。在部分类型的手术中这一问题尤为凸显,包括截肢手术(30%~50%)、乳腺癌手术(20%~30%)和开胸手术(30%~60%),其中有2%~10%的患者受到严重的术后慢性疼痛困扰,甚至丧失工作及生活能力。术后慢性疼痛常由严重的术后急性疼痛发展而来,伴随着手术创伤后机体一系列复杂的病理过程。要减少术后慢性疼痛的发生,一个能够合理而有效地控制术后急性疼痛的围术期镇痛方案显得尤为重要。局部麻醉药作为能够可逆性阻断神经冲动传导的药物,以及其良好的安全性能,在临床被广泛使用于阻断术后疼痛。越来越多的证据表明,手术过程中的神经损伤及手术后炎症反应所导致的外周及中枢敏化是术后慢性疼痛发生及发展中比较重要的影响因素。局部麻醉药阻滞信号传导及抗炎作用的药理性质与术后慢性疼痛的发生机制有紧密的联系。本文就局部麻醉药降低术后慢性疼痛发生的机理以及其将来的应用前景做一综述,为更好地理解局部麻醉药在预防术后慢性疼痛发生中的作用以及对术后慢性疼痛产生更有效的治疗,提出新的思路。

Despite researches that have been thoroughly done on the mechanism of pain and the appeals for standardized management of pain,the high incidence of chronic post-surgical pain(CPSP)is still a serious problem in clinical work.The problem remains particularly in certain types of surgery as amputation(30%-50%),breast cancer surgery(20%-30%)and thoracotomy(30%-60%),among which 2%-10%patients have suffered from severe CPSP and even lost their ability to live and work.CPSP often develops from severe acute post-surgical pain,accompanied by a complex pathological process after surgical trauma.Therefore,a rational and effective perioperative analgesia management of acute post-surgical pain is real important for reducing CPSP.Local anesthetics,which can reversibly block the conduction of nerve impulse,are widely used in clinical practice to treat postoperative pain for its safety and efficacy.Growing evidences show that peripheral and central sensitization caused by nerve injury during operation and inflammation after operation are vital factors in pathophysiology and development of CPSP.The pharmacological properties of local anesthetics in blocking signal transduction and anti-inflammatory are closely connected with the mechanism of CPSP.This article reviews the main pharmacologic properties of local anesthetics in treating CPSP,discusses the future broad application as well as the limits of local anesthetics and considers better strategies to help treat CPSP.