Management of pain with regional analgesia.
نویسنده
چکیده
Regional analgesia has been used for the management of acute pain for nearly a century. Local analgesia and somatic nerve blocks interrupt nociceptive input at its source or block nociceptive fibres in peripheral nerves. Blockade also interrupts the afferent limb of abnormal reflex mechanisms that may contribute to the pathogenesis of some pain syndromes. Moreover, since sympathetic fibres destined for somatic structures, particularly the limbs, course through somatic spinal nerves, blocking these may eliminate the sympathetic hyperactivity that often contributes to the pathogenesis of certain pain syndromes. Local anaesthetics in low concentration block the unmyelinated C and B fibres and small myelinated A delta fibres without blocking somatic motor function. On the other hand, in certain conditions it may be useful to block somatomotor nerves to relieve severe muscle spasm. By producing one or more of these effects, there is often prompt pain relief lasting for varying lengths of time depending on the concentration and characteristics of the local anaesthetic used. In certain conditions, pain relief outlasts by hours and sometimes days and weeks the transient pharmacological action of local anaesthetics. It has been suggested that block of sensory input for several hours stops the selfsustaining activity of the neurone pools in the neuraxis that may be responsible for some chronic pain states (Bonica, 1953; Melzack and Wall, 1980).
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ورودعنوان ژورنال:
- Postgraduate medical journal
دوره 60 710 شماره
صفحات -
تاریخ انتشار 1984