Douleur et Analgésie

, 22:26 | Cite as

Place des blocs analgésiques dans la prévention de la douleur chronique postopératoire

Article de Synthèse / Synthesis Article

Résumé

Parmi les facteurs prédisposant aux douleurs chroniques postopératoires (DCPO), la littérature confirme qu’il faut considérer ceux liés aux patients (histoire douloureuse antérieure, état émotionnel, patrimoine génétique) et ceux liés à l’acte chirurgical lui-même et à la sévérité de la douleur postopératoire précoce (DPO) qu’il induit. L’apparition et la persistance de modifications de l’intégration périphérique et centrale des messages nociceptifs d’origine inflammatoire puis secondaires aux lésions neuropathiques potentiellement induites par l’acte chirurgical sont, ici, au premier plan. Il est maintenant bien établi qu’une prise en charge optimale de la DPO réduit la sévérité de celle-ci et le risque de survenue de DCPO. Parmi les stratégies antalgiques mises en oeuvre, l’analgésieanesthésie locorégionale apparaît la plus efficace. Son action bloquante des canaux sodiques réduit, en effet, fortement les mécanismes de sensibilisation périphérique et centrale, facilite l’acte chirurgical et jouerait un rôle à distance sur la prévention de la DCPO.

Mots clés

Douleur chronique postopératoire Analgésie locorégionale Prévention de la douleur chronique 

Role of analgesic blocks in preventing chronic postoperative pain

Abstract

Postoperative chronic pain is common and remains an essential issue. Various factors favour its development: sustained high-level of postoperative pain, patient mood and internal locus control, efficiency of pain central modulatory system, gender and genetic characteristics. Nerve lesions related to the surgical trauma are one of the most contributive factors, but persistent nociceptive inputs due to inflammation are also involved. Indeed, central sensitization due to nociceptive barrage leads to sustained neuronal hyperexcitability. Adequate and efficient pain relief during the perioperative period prevents such events, and facilitates surgery, thus reducing the risk of nerve lesions. Among multimodal pain relief strategies, locoregional analgesia per- and postoperatively is one of the most powerful techniques and prevents chronic postoperative pain by reducing central sensibilization mechanisms.

Keywords

Chronic postoperative pain Locoregional analgesia Prevention of chronic pain 

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Copyright information

© Médecine et Hygiène et Springer-Verlag France 2009

Authors and Affiliations

  1. 1.Centre d’étude et de traitement de la douleurhôpital NordSaint-ÉtienneFrance

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