Canadian Journal of Anesthesia

, Volume 53, Issue 6, pp 562–571 | Cite as

Review article: The role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective

Regional Anesthesia And Pain

Abstract

Purpose

Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management.

Source

A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management.

Principal findings

Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain.

Conclusion

Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted.

Le rôle des anticonvulsivants dans le traitement de la douleur postopératoire : perspective ďune application

Résumé

Objectif

Les anticonvulsivants sont efficaces contre la douleur neuropathique chronique mais, jusqu’à tout récemment, on ne les croyait pas utiles pour traiter les douleurs aiguës, comme les douleurs postopératoires. La lésion tissulaire chirurgicale, comme la lésion nerveuse, produit des modifications neuroplastiques menant à une sensibilisation rachidienne et à ľexpression ďhyperalgésie et ďallodynie provoquées par un stimulus. Les effets pharmacologiques des anticonvulsivants, dont la suppression de ľactivité des récepteurs du canal sodique, du canal calcique et du glutamate aux sites périphérique, rachidien et suprarachidien, peuvent être importants dans la modulation de ces changements nerveux postopératoires. Nous voulions revoir la preuve clinique et les données ďétudes cliniques décrivant ľefficacité et ľinnocuité des anticonvulsivants pour traiter la douleur postopératoire.

Source

Nous avons extrait de Medline les articles sur la pharmacologie théorique et clinique des anticonvulsivants comme traitement de la douleur postopératoire.

Constatations principales

De nombreuses études de laboratoire ont décrit les effets analgésiques de différents anticonvulsivants pour des modèles de douleur expérimentaux. En outre, quelques récentes études cliniques ont montré qu’ils pouvaient réduire la douleur spontanée et provoquée par le mouvement, et aussi les besoins postopératoires ďopioïdes. Certains résultats précoces suggèrent qu’ils puissent atténuer ľanxiété postopératoire, accélérer la récupération fonctionnelle postopératoire et réduire la douleur postchirurgicale chronique.

Conclusion

Étant donné ľefficacité réduite des analgésiques non opioïdes actuellement offerts et les bénéfices connus de ľéconomie des opioïdes, les anticonvulsivants peuvent compléter ľanalgésie postopératoire. La recherche doit se poursuivre dans ce domaine.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  1. 1.Departments of Anesthesiology and Pharmacology & ToxicologyKingston General Hospital, Queen’s UniversityKingstonCanada

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