Regional Anaesthesia Analgesia and Pain Management: Basics, Guidelines and Clinical Orientation

339 Pages·1999·6.31 MB·English

by  A. Cestelli

Topics in Anaesthesia and Critical Care
H.K.F. VAN SAENE, 1. SILVESTRI, M.A. DE LA CAL (EDS)
Infection Control in the Intensitive Care unit
1998,380 pp, ISBN 3-540-75043-6
J. MILlC-EMILI (ED)
Applied Physiology in Respiratory Mechanics
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G. GUARNIERI, F. ISCRA
Metabolism and Artificial Nutrition in the Critically III
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J. MILIC -EMILI, U. LUCANGELO, A. PESENTI, W.A. ZIN
Basics of Respiratory Mechanics and Artificial Ventilation
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M. TIENGo, V.A. PALADINI, N. RAWAL
Regional Anaesthesia, Analgesia and Pain Management
1999,362 pp, ISBN 88-470-0044-0
I. SALVO, D. VIDYASAGAR
Anaesthesia and Intensive Care in Neonates and Children
1999,324 pp, ISBN 88-470-0043-2
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Trauma Operative Procedures
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Anestesia e Medicina Critica
G. SLAVICH
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1997,328 pp, ISBN 3-540-75050-9
G.1. ALATI, B. ALLARIA, G. BERLOT, A. GULLO, A. LUZZANI,
G. MARTINELLI, 1. TORELLI
Anestesia e Malattie Concomitanti - Fisiopatologia e clinica del
periodo perioperatorio
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G. MANANI, G. MARTINELLI,A. PASETTO,1. TORELLI
Farmacologia Generale e Speciale in Anestesiologia Clinica
1997,312 pp, ISBN 88-470-0001-7
A. GULLO
Anestesia Clinica
1998,506 pp, ISBN 88-470-0038-6
Regional Anaesthesia
Analgesia and Pain Management
Springer
Milano
Berlm
Hetdelberg
New York
Barcelona
Hong Kong
London
Paris
Smgapore
Tokyo
M. Tiengo
V.A. Paladini
N. Rawal (Eds)
Regional Anaesthesia
Analgesia and
Pain Management
Basics, Guidelines and Clinical Orientation
Series edited by
Antonino Gullo
t
Springer
M. TIENGO, MD
Professor Emeritus
University of Milan, Milan -Italy
V.A. PA LADINI, MD
Department of Anaesthesia, Intensive Care and Pain Therapy
University of Trieste, Cattinara Hospital, Trieste -Italy
N.RAWAL,MD
Department of Anaesthesiology and Intensive Care
Orebro University Hospital, Orebro -Sweden
Series of TopIcs in AnaesthesIa and Cntlcal Care edited by
A. GULLO, MD
Department of Anaesthesia, Intensive Care
and Pain Therapy
University of Trieste, Cattinara Hospital, Trieste -Italy
© Springer Verlag Italia, Milano 1999
ISBN 978-88-470-0044-5 ISBN 978-88-470-2240-9 (eBook)
DOT 10.1007/978-88-470-2240-9
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Foreword
Local-regional anaesthesia and pain therapy represent two areas of common in
terest for all physicians. A thorough preparation in functional anatomy and gen
eral pharmacology, including familiarity with local anaesthetics and analgesics is
considered fundamental background for further study or clinical application of
such techniques. Knowledge of the mechanisms of action, efficacies and side ef
fects of the relevant drugs is essential, as is appreciation of possible drug inter
actions to evaluate toxic effects.
Local-regional anaesthesia and pain management are being increasingly used
in diverse medical specialties, including those requiring manual dexterity. Many
medical specialities such as obstetrics, orthopedics and traumatology, particu
larly with geriatric patients, and many scientific societies have developed guide
lines to assist in choosing the most efficient and appropriate clinical approach,
especially when the use of invasive techniques is required. Such guidelines direct
the treatment of acute post-operative pain, the management of pain associated
with cancer, and the medical support of terminally ill patients who present a se
ries of overlapping symptoms such as pain, anxiety, and fear, and who often re
quire personalized therapeutic care. Given the difficulty of these issues, it is im
portant to consider the manner in which a physician obtains the patient's au
thorization for new therapies. Patient consent is most critical when the clinician,
for scientific or ethical reasons, chooses a therapy that is experimental or in
which the medical staff's experience is insufficient. In this context in particular,
and in all cases in which local-regional anaesthesia and analgesia are utilized, le
gal issues assume prominent levels as a result of the expectations that the patient
has regarding both the illness and the physician's competence.
Therefore, in contemporary medicine, and in particular in the fields of local
regional anaesthesia and pain treatment, correct evaluation of the medical out
come becomes essential, especially in relation to the cost-benefit balance: ob
viously not only in terms of resources consumed (i.e. budget), but also and more
importantly for the quality of life of the patient.
November, 1998 Antonino Gullo, MD
Contents
PATHOPHYSIOLOGY OF PAIN AND GENETIC ADVANCE
Chapter 1 -Integrated axon-synapse unit in the central nervous system
A. Cestelli, G. Savettieri, 1. Di Liegro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 -Neurochemical memory in pain circuits
L. Calza, M. Pozza, M. Zanni. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 3 -Withdrawal reflex: phylosophy and physiology
M. Tiengo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 4 -Pathophysiology of pain modulation
C.J. Glynn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 5 -Role of the central nervous system in processing
pain stimuli and perspectives of pharmacological intervention
E. Masoero, L. Favalli, S. Govoni .................................. 67
Chapter 6 -Pain and the genome
M.E. Ferrero, A. Fulgenzi, M. Tiengo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
PHARMACOLOGY
Chapter 7 -Clinical pharmacology of local anaesthetic agents
L.E. Mather, D.H.-T. Chang ......... " ........... " . " ...... , . .. . 91
Chapter 8 -Drug interactions and systemic toxicity
H. Adriaensen ................................................. 113
Chapter 9 -Placental transfer of pharmacological agents
E. Margaria, 1. Castelletti, P. Petruzzelli .. . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
Chapter 10 -Clinical perspectives of cholecystokinin
antagonists in pain management
M. Amanzio, F. Benedetti. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 127
VIII Contents
Chapter 11 -Clinical pharmacology of non-steroidal
anti-inflammatory drugs: novel acquisitions
A. Sala, R. Ballerio, S. Viappiani, S. Zarini . . . . . . . . . . . . . . . . . . . . . . . . . .. 135
Chapter 12 -Opioids
A.E. Panerai, M. Bianchi, P. Ferrario, P. Sacerdote 141
Chapter 13 -Psychoactive drugs and pain
K. Kouyanou... ................. . . .... .................. ..... .. 147
REGIONAL TECHNIQUES
Chapter 14 -Trigeminal neuralgia and atypical facial pain:
current concepts on etiopathogenesis and diagnosis
G. Broggi, I. Dones, P. Ferroli, D. Servello. . . . . . . . . . . . . . . . . . . . . . . . . .. 159
Chapter 15 -Trigeminal nerve block and surgery
G. Broggi, A. Franzini, P. Ferroli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
Chapter 16 -Cervical plexus block
D. Lugani, A. Casati, G. Fanelli. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 187
Chapter 17 -Neuroaxial analgesia: epidural and spinal drugs
N. Rawal ............ ........................... ............... 195
Chapter 18 -Combined spinal epidural anaesthesia
M. Berti,A. Casati, G. Fanelli..... ................................ 201
Chapter 19 -Imaging for regional block:
clinical applications of sympathetic blockade in pain therapy
L. Branca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 209
Chapter 20 -Postoperative advantages of regional anaesthesia
F. Nicosia, M. Nolli. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219
ORGANIZATION OF PAIN SERVICE
Chapter 21 -Organization of acute pain services
N. Rawal ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 227
Contents IX
REGIONAL ANAESTHESIA IN SPECIALTIES
Chapter 22 -Regional analgesia and anaesthesia in obstetrics
C. Benedetti, M. Mercieri. .. .. ............. . ............ .. ..... ... 237
Chapter 23 -Regional anaesthetic techniques in orthopaedics
E Bonnet, M. Osman, A. Babinet-Berthier . . . . . . . . . . . . . . . . . . . . . . . . .. 257
GUIDELINES OF ACUTE AND CHRONIC PAIN MANAGEMENT
Chapter 24 -Guidelines on acute postoperative pain management
G. Savoia, G. Scibelli, R. Gammaldi . ... . . . ... . . . .. . . . .. .. .. .. . .. ... 271
Chapter 25 -Guidelines on chronic pain management
S. Ischia, G. Finco, E. Polati, L. Gottin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 285
Chapter 26 -Terminal cancer illness: strategies and management
V.A. Paladini, B. Barbolan, L. Di Bello, A. Zamperoni . . . . . . . . . . . . . . . .. 295
COST-EFFECTIVENESS OF LOCO-REGIONAL ANAESTHESIA
Chapter 27 -Cost effectiveness of anaesthesia/analgesia
Q. Piacevoli, ES. Mennini, E Palazzo, E. Ferrari Baliviera . . . . . . . . . . . . .. 331
Main symbols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 339
Subject index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 341
Contributors
Adriansen H.
Department of Anaesthesiology, University Hospital of Antwerp, Edegem, Bel
gium.
AmanzioM.
Department of Neuroscience and CIND Center for the Neurophysiology of
Pain, University of Turin Medical School, Turin, Italy.
Babinet -Berthier A.
Department of Anaesthesiology, Hopital Tenon, Paris, France.
Ballerio R.
Center for Cardiopulmonary Pharmacology, Institute of Pharmacological Sci
ences, University of Milan, Milan, Italy.
BarbolanB.
Department of Anaesthesia, Intensive Care and Pain Therapy, University of
Trieste, Cattinara Hospital, Trieste, Italy.
Benedetti C.
Anesthesia Pain Services, The Ohio State University, James Cancer Hospital,
Columbus, USA.
Benedetti F.
Department of Neuroscience and CIND Center for the Neurophysiology of
Pain, University of Turin Medical School, Turin, Italy.
BertiM.
Department and Chair of Anaesthesiology, University of Milan, IRCCS San Raf
faele Hospital, Milan, Italy.
BianchiM.
Department of Pharmacology, University of Milan, Milan, Italy.
BonnetF.
Department of Anaesthesiology, Hopital Tenon, Paris, France.