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Antiépileptiques et antihyperalgésie péri-opératoire: état des lieux

  • Chapter
La douleur chronique post-chirurgicale

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Résumé

Le rationnel pour l’utilisation d’antiépileptiques (AE) dans une stratégie d’analgésie multimodale péri-opératoire est basé sur un double constat, à la fois empirique et théorique. L’abord chirurgical provoque des lésions tissulaires et nerveuses qui conduisent à des manifestations d’hyperalgésie primaire au site lésionnel et secondaire en périphérie de celui-ci. Ces lésions sont ainsi à l’origine d’une hyperexcitabilité neuronale, en particulier au niveau de la corne dorsale de la moelle, phénomène communément appelé sensibilisation. Deux hypothèses ont été émises : 1) l’hyperexcitabilité neuronale médullaire impliquée dans les phénomènes d’hyperalgésie est liée pour une part à la transmission de l’information nociceptive au travers de synapses dont l’activité dépend de l’ouverture de canaux calciques voltage-dépendants, et pourrait donc être réduite par des AE susceptibles de bloquer ces canaux ; 2) des lésions nerveuses étant induites par la chirurgie, certains AE étant des traitements des douleurs neuropathiques, leur utilisation pourrait prévenir l’apparition de douleurs post-opératoires chroniques. Tous les AE n’ont pas été, à ce jour, utilisés dans les stratégies d’analgésie multimodale.

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  1. Clinique d’anesthésie réanimation, secteur douleur, Hôpital Claude Huriez, CHRU Lille, 59037, Lille Cedex, France

    J.-M. Wattier

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Wattier, JM. (2013). Antiépileptiques et antihyperalgésie péri-opératoire: état des lieux. In: La douleur chronique post-chirurgicale. Springer, Paris. https://doi.org/10.1007/978-2-8178-0026-4_11

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  • DOI: https://doi.org/10.1007/978-2-8178-0026-4_11

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0025-7

  • Online ISBN: 978-2-8178-0026-4

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