흉강절제술 후 통증모델에서 수술 전 늑간신경차단의 효과
Effect of the Preoperative Intercostal Nerve Block in a Rat Model of Postthoracotomy Pain
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Background: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. Methods: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. Results: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P ＜ 0.05). Conclusions: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome. (Korean J Pain 2008; 21: 106-111)
Abstract
Background: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. Methods: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. Results: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P ＜ 0.05). Conclusions: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome. (Korean J Pain 2008; 21: 106-111)
참고문헌 (26)
- Blades B, "War wounds of the chest observed at the Thoracic Surgery Centre Walter Reed General Hospital", J Thorac Surg, 13, pp.294~306 (1944)
- Merskey H, "Classification of chronic pain: description of chronic pain syndromes and definitions of pain terms", Pain, 3, pp.138~9 (1986)
- Dajczman E, "Long- term postthoracotomy pain", Chest, 99, pp.270~4 (1991)
- Katz J, "Acute pain after thoracic surgery predicts long-term post-thoracotomy pain", Clin J Pain, 12, pp.50~5 (1996)
- Perkins FM, "Chronic pain as an outcome of surgery. A review of predictive factors", Anesthesiology, 93, pp.1123~33 (2000)
- Keller SM, "Chronic post thoracotomy pain", J Cardiovasc Surg (Torino), 35(1), pp.161~4 (1994)
- Landreneau RJ, "Acute and chronic morbidity differences between muscle-sparing and standard lateral thoracotomies", J Thorac Cardiovasc Surg, 112, pp.1346~50 (1996)
- Landreneau RJ, "Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery", J Thorac Cardiovasc Surg, 107, pp.1079~85 (1994)
- Rogers ML, "Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy", Eur J Cardiothorac Surg, 21, pp.298~301 (2002)
- Buvanendran A, "Characterization of a new animal model for evaluation of persistent postthoracotomy pain", Anesth Analg, 99, pp.1453~60 (2004)
- Vranken JH, "Continuous sacral nerve root block in the management of neuropathic cancer pain", Anesth Analg, 95, pp.1724~5 (2002)
- Challapalli V, "Systemic administration of local anesthetic agents to relieve neuropathic pain", Cochrane Database Syst Rev, 19 (2005)
- Vranken JH, "Continuous brachial plexus block as treatment for the Pancoast syndrome", Clin J Pain, 16, pp.327~33 (2000)
- Chaplan SR, "Quantitative assessment of tactile allodynia in the rat paw", J Neurosci Methods, 53, pp.55~63 (1994)
- Sabanathan S, "Has postoperative pain been eradicated?", Ann R Coll Surg Engl, 77, pp.202~9 (1995)
- Benedetti F, "Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations", Ann Thorac Surg, 63, pp.773~6 (1997)
- Gerner P, "Post thoracotomy pain management problems", Anesthesiol Clin, 26, pp.355~67 (2008)
- Benedetti F, "Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy", J Thorac Cardiovasc Surg, 115, pp.841~7 (1998)
- Rogers ML, "Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy", Eur J Cardiothorac Surg, 21, pp.298~301 (2002)
- Richardson J, "Efficacy of pre-emptive analgesia and continuous extrapleural intercostal nerve block on post- thoracotomy pain and pulmonary mechanics", J Cardiovasc Surg (Torino), 35, pp.219~28 (1994)
- Moiniche S, "A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia", Anesthesiology, 96, pp.725~41 (2002)
- Perttunen K, "Chronic pain after thoracic surgery: a follow-up study", Acta Anaesthesiol Scand, 43, pp.563~7 (1999)
- Katz J, "Acute pain after thoracic surgery predicts long-term post-thoracotomy pain", Clin J Pain, 12, pp.50~5 (1996)
- Bach S, "Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade", Pain, 33, pp.297~301 (1988)
- Niiyama S, "Bupivacaine, but not tetracaine, protects against the in vitro ischemic insult of rat hippocampal CA1 neurons", Neurosci Res, 42, pp.231~41 (2002)
- Bacher A, "Lamotrigine inhibits extracellular glutamate accumulation during transient global cerebral ischemia in rabbits", Anesthesiology, 86, pp.459~63 (1997)