Application of current pain management concepts to the prevention and management of postoperative pain.

摘要

To understand what occurred in this patient, one has to understand the mechanisms involved in the development of postsurgical pain.1 Such pain generally reaches its peak intensity after six to eight hours. By that time, the effects of the local anesthetic have worn off. The aching pain is a result of nociceptive activity in the peripheral terminal nerve endings of the unmy-elinated C fibers of the trigeminal nerve in response to the liberation of a variety of algo-genic substances and inflammatory mediators by surgical trauma. These include the prosta-glandins and bradykinin, released from injured cells, and the leukotrienes, liberated from the leukocytes, lymphocytes, mast cells, eosinophils and monocytes attracted to the site as part of the inflammatory process.