[A review of clinical evidence supporting techniques to prevent chronic postoperative pain syndromes].
OBJECTIVE
To conduct a systematic review to evaluate the level of evidence for using acute postoperative pain management techniques with a view to pre-empting the later development of chronic pain syndromes.


METHODS
Systematic review of the literature on the treatment of acute postoperative pain and its usefulness in preventing postoperative chronic pain syndromes.


RESULTS
Fifteen studies focusing on 3 conditions were examined: chronic postmastectomy pain syndrome, chronic postthoracotomy pain syndrome, and chronic phantom limb pain. Four clinical trials provided no clear evidence of benefit from preoperative injections of local anesthetic in decreasing the incidence of chronic postmastectomy pain. Continuous thoracic epidural analgesia started before surgery has been shown to have a clearly beneficial effect in preventing chronic pain 3, 6, and 12 months after thoracotomy. Chronic phantom limb pain syndromes have not been found to be prevented by the use of continuous epidural analgesia started before or after surgery in comparison with the injection of local anesthetics through a perineural catheter or the oral or intramuscular administration of morphine-like drugs.


CONCLUSIONS
Only chronic pain following thoracotomy has been found to be preempted by acute pain management and only by continuous thoracic epidural analgesia started before surgery. There is no solid evidence demonstrating that other techniques used to relieve acute postoperative pain have a beneficial effect in preempting chronic postoperative pain syndromes.
Durá Navarro
R
R
Unidad Multidisciplinar de Tratamiento del Dolor, Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General, Universitario de Valencia. dura_raq@gva.es
De Andrés Ibáñez
J
J
D000671:Amputation, Surgical / Q000009:adverse effects; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D013907:Thoracostomy / Q000009:adverse effects