Chapters authored
Regional Anesthesia in the Prevention of Chronic Postoperative Pain
Chronic postsurgical pain (CPSP) develops after a surgical procedure but increases its intensity and persists beyond the healing process without another cause to explain it. The incidence ranges from 5–85%, according to the type of surgery. Patients who develop CPSP may have a protracted ambulation, cardiac and pulmonary complications and increased morbidity and mortality. Several risk factors have been found related to the development of CPSP: female gender, young age, genetic predisposition, and psychosocial problems, hence prevention, early identification and treatment of these factors is essential. Several guidelines recommend the use of multimodal analgesia to treat postoperative pain, and the perioperative management seems to have a preventive role in the development of CPSP. Regional anesthesia (RA) either neuraxial or peripheral nerve blocks, by modulating signaling created by a surgical incision, play a key role in the prevention of CPSP. Local anesthetics have anti-inflammatory properties which decrease sensitization, reduce ectopic firing of neurons, cytokines expression and decrease neutrophil priming. RA reduces pain signals to the spinal cord and supraspinal and cortical nociceptive centers. RA along with other pharmacologic interventions can improve the CPSP as well as the physical and social functionality.
Part of the book: Topics in Regional Anesthesia