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Canadian Journal of Anesthesia 48:1000-1010 (2001)
© Canadian Anesthesiologists' Society, 2001
Regional Anesthesia and Pain

Preemptive analgesia I: physiological pathways and pharmacological modalities

[L'analgésie préventive I : mécanismes physiologiques et modalités pharmacologiques]

Dermot J. Kelly, MRCPI FFARCSI*, Mahmood Ahmad, MD{dagger} and Sorin J. Brull, MD{dagger}

* From the Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland and
{dagger} the Department of Anesthesiology University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Dr. Sorin J. Brull, Professor and Chairman, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 515, Little Rock, AR 72205-7199, USA. Phone: 501-686-6119; Fax: 501-603-1421; E-mail: Sorin.Brull{at}uams.edu

Objectif :La présente revue, en deux parties, résume les connaissances actuelles sur les mécanismes physiologiques et les modalités pharmacologiques de l'analgésie préventive ainsi que sur les questions controversées qui l'entourent.

Sources : Des articles, de 1966 à aujourd'hui, obtenus à partir des bases de données MEDLINE. Les termes de la recherche comprennent : analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents.

Constatations principales : Les fondements physiologiques de l'analgésie préventive sont complexes et impliquent une modification des mécanismes de la douleur. Les modalités pharmacologiques disponibles peuvent modifier les réponses physiologiques à différents niveaux. Les techniques efficaces d'analgésie préventive exigent l'interception multimodale du stimulus nociceptif, la hausse du seuil de nociception et le blocage ou la baisse de l'activation des récepteurs de nociception. Même si la documentation est controversée concernant l'efficacité de l'analgésie préventive, certaines recommandations générales peuvent guider les soins cliniques. L'anesthésie régionale induite avant le trauma chirurgical et poursuivie après l'opération est efficace pour diminuer la sensibilisation centrale et périphérique. Les agents pharmacologiques comme les AINS (anti-inflammatoires non stéroïdiens), les opioïdes et les antagonistes des récepteurs alpha-2 et NMDA (N-méthyl-D-aspartate), surtout lorsqu'ils sont combinés, agissent en synergie pour réduire la douleur postopératoire.

Conclusion : La diversité des patients et le moment choisi pour administrer l'analgésie préventive en relation avec le stimulus chirurgical nocif demandent l'individualisation de la, ou des, technique choisie. Des techniques analgésiques multimodales semblent plus efficaces.




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This Article
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