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Advisor(s)
Abstract(s)
Provavelmente mais nenhum sintoma causa tanto medo e repugnância como dor
crónica. Aliado a esse medo associa-se o desconhecimento atual dos mecanismos exatos
por trás da dor crónica e o que causa atrasos no desenvolvimento de um tratamento
farmacológico eficaz. A evidencia científica atual é incapaz de chegar a um consenso no
que toca ao tratamento destes pacientes. Por agora, põe-se a hipótese que a dor crónica
é devido a uma sensibilização do sistema nervoso central. Ainda mais, sabe-se que a lesão
cirúrgica leva a hipersensibilidade pós-operatória que precede esta sensibilização.
Assim, pela sua caraterística iatrogénica, torna-se vital atuar sobre esta fonte potencial
de dor crónica.
Nos dias de hoje, os opióides são administrados no momento de ressuscitação de trauma,
preoperatoriamente, durante anestesia geral e regional como um componente da própria
anestesia e para iniciar a analgesia pós-operatória. Para além dos seus efeitos adversos,
tolerância e possível hiperalgesia, ainda poderão causar depressão respiratória e
comorbilidades, aumentando o risco para a segurança do paciente. Estes riscos abrem
caminho para novas abordagens acerca da analgesia multimodal e sua inovação.
Os anticonvulsivantes como a pregabalina e a gabapentina atuam por dessensibilização
do sistema nervoso. Como tal, seria racional que o uso desta classe farmacológica
ajudasse na prevenção e tratamento da dor crónica. Muitos autores aceitam como
hipótese que os anticonvulsivantes poderão ser usados como analgesia preventiva uma
vez que protege contra a sensibilização do SNC que causa rearranjos neuronais
permanentes e, consequentemente, dor crónica. Nesta monografia, tentamos investigar
a evidencia científica atual acerca do impacto do uso de anticonvulsivantes no
perioperatório no controlo da dor crónica no período pós-operatório.
Perhaps no other symptom induces such fear and loathing as chronic pain. Allied to that fear is the current misunderstanding of the exact mechanisms involving chronic pain and, therefore, the development of a treatment is impaired. Currently, scientific evidence is unable to reach a consensus on how to treat these patients. For now, the latest hypothesis regarding the topic is that chronic pain is due a sensibilization of the central nervous system. Moreover, it’s known that surgical injury leads to postoperative pain hypersensitivity preceded by central nervous sensitization. Being iatrogenic, it’s vital to act on this potentially avoidable source of chronic pain. These days, opioids are currently administered at the time of trauma resuscitation, preoperatively, during general and regional anaesthesia as a component of the anaesthetic itself, and to initiate postoperative analgesia. Besides opioid-related side effects, tolerance and possible hyperalgesia, they cause respiratory depression, increase patient comorbidities and influence other drugs therapy, increasing the risk to patient safety. These risks make way to new approaches of multimodal analgesia and its innovation. Anticonvulsants such as pregabalin and gabapentin act by desensibilization of the nervous system. As such, it would be rational that the use of this pharmacologic group would aid in the prevention and treatment of chronic pain. Many authors hypothesise that antiepileptics have proprieties that can be used as pre-emptive analgesia as it will protect against sensibilization of the CNS that causes permanent neuronal rearrangement and, therefore, chronic pain. In this monography, we aim to investigate the current scientific evidence on the impact of anticonvulsants perioperative use on chronic pain management in the post-operatory period.
Perhaps no other symptom induces such fear and loathing as chronic pain. Allied to that fear is the current misunderstanding of the exact mechanisms involving chronic pain and, therefore, the development of a treatment is impaired. Currently, scientific evidence is unable to reach a consensus on how to treat these patients. For now, the latest hypothesis regarding the topic is that chronic pain is due a sensibilization of the central nervous system. Moreover, it’s known that surgical injury leads to postoperative pain hypersensitivity preceded by central nervous sensitization. Being iatrogenic, it’s vital to act on this potentially avoidable source of chronic pain. These days, opioids are currently administered at the time of trauma resuscitation, preoperatively, during general and regional anaesthesia as a component of the anaesthetic itself, and to initiate postoperative analgesia. Besides opioid-related side effects, tolerance and possible hyperalgesia, they cause respiratory depression, increase patient comorbidities and influence other drugs therapy, increasing the risk to patient safety. These risks make way to new approaches of multimodal analgesia and its innovation. Anticonvulsants such as pregabalin and gabapentin act by desensibilization of the nervous system. As such, it would be rational that the use of this pharmacologic group would aid in the prevention and treatment of chronic pain. Many authors hypothesise that antiepileptics have proprieties that can be used as pre-emptive analgesia as it will protect against sensibilization of the CNS that causes permanent neuronal rearrangement and, therefore, chronic pain. In this monography, we aim to investigate the current scientific evidence on the impact of anticonvulsants perioperative use on chronic pain management in the post-operatory period.
Description
Keywords
Ácido
Valpróico Anticonvulsivantes Carbamazepina Dor Crónica Etossuximida Fenitoína Fenobarbital Gabapentina Lamotrigina Oxcarbazepi Na Pós-Operatório Pregabalina Topiramato