Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2025
ReviewN-Methyl-D-aspartate receptor antagonists for the prevention of chronic postsurgical pain: a narrative review.
The N-methyl-D-aspartate receptor (NMDAR) has been linked to the development of chronic postsurgical pain (CPSP), defined as pain after surgery that does not resolve by 3 months. Once the combination of a painful stimulus and glutamate binding activates the NMDAR, calcium influx triggers signaling cascades that lead to processes like central sensitization and CPSP. Three of the most widely studied perioperative NMDAR antagonists include ketamine, magnesium, and methadone, with ketamine having garnered the greatest amount of attention. ⋯ Existing meta-analyses of ketamine for CPSP are inconsistent in their findings, and studies of magnesium and methadone are even more limited. Overall, the evidence supporting NMDAR antagonists for CPSP is weak and we recommend that future studies focus on high-risk patients and potentially include combinations of NMDAR antagonists administered together for the longest duration feasible. The results of ongoing trials could have a major influence on the overall direction of the evidence supporting NMDAR antagonists in preventing CPSP.
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Reg Anesth Pain Med · Feb 2025
Review Meta AnalysisPrognostic factors of chronic postsurgical pain in children and adolescents: a systematic review and meta-analysis.
Approximately 28% of children and adolescents undergoing major surgery develop chronic postsurgical pain (CPSP; pain persisting>3 months). A previous review attempted to investigate biopsychosocial prognostic factors for pediatric CPSP; however, due to lack of data, no meta-analytic techniques were employed. Since that review, numerous studies have investigated risk/protective factors that fall within an Interpersonal Fear Avoidance Model for CPSP, thus warranting a reinvestigation of prognostic factors. ⋯ CRD42022306340.
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Chronic pain after surgery, also known as chronic postsurgical pain (CPSP), is recognized as a significant public health issue with serious medical and economic consequences. Current research on CPSP underscores the significant roles of both peripheral and central sensitization in pain development and maintenance. Peripheral sensitization occurs at the site of injury, through the hyperexcitability of nerve fibers due to surgical damage and the release of inflammatory mediators. ⋯ These glial cells release substances that further increase neuronal excitability, maintaining the sensitized state and contributing to persistent pain. The activation of antinociceptive systems is required for the resolution of pain after surgery, and default in these systems may also be considered as an important component of CPSP. In this review, we will examine the clinical factors underlying CPSP in patients and the mechanisms previously established in preclinical models of CPSP that may explain how acute postoperative pain may transform into chronic pain in patients.