title: Perioperative interventions to reduce chronic postsurgical pain.
abstract: Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.
authors: Department of Anesthesiology, Division of Pain Management, Stanford School of Medicine, Palo Alto, CA, USA. irc39@pain.stanford.edu
authors: Ian
authors: I
authors: Carroll
authors: Jennifer
authors: J
authors: Hah
authors: Sean
authors: S
authors: Mackey
authors: Einar
authors: E
authors: Ottestad
authors: Jiang Ti
authors: JT
authors: Kong
authors: Sam
authors: S
authors: Lahidji
authors: Vivianne
authors: V
authors: Tawfik
authors: Jarred
authors: J
authors: Younger
authors: Catherine
authors: C
authors: Curtin
mesh_terms: D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use; D000777:Anesthetics / Q000008:administration & dosage; D059350:Chronic Pain / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D009437:Neuralgia / Q000517:prevention & control; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care; D011292:Premedication; D019651:Plastic Surgery Procedures
chemical_list: D000700:Analgesics; D000777:Anesthetics