Professor Narinder Rawal, MD, PhD, FRCA (Hon) - AKUTNE.CZ

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Persistent postsurgical pain Mechanism – pathophysiology Prevalence Risk factors Role of surgical technique Issue of unnecessary surgery Can persistent postsurgical pain be prevented?The role of analgesic techniques
1. Local and systemic chemicals drivepain signalling2. Neuroma at injury site - excitabilityin sensory fibres3. Changes in gene expression indorsal front ganglion4. Dorsal horn - central sensitization5. Descending controls modulatetransmission in spinal cord6. Limbic system and hypothalamus -altered mood, behaviour7. Sensation of pain generated incortex (past experiences, culturalinputs, expectations)8. Genomic DNA predispose (or not)patient for chronic pain
Page 1: Professor Narinder Rawal, MD, PhD,
Page 5 and 6: Chronic postsurgical painGenetic pr
Page 7 and 8: It´s not only nerve damage"Damage
Page 9 and 10: Persistent postsurgical pain - role
Page 11: Non-opioid opioid analgesic techniq
Page 14 and 15: Anesth Analg 2006;102:248-57 19 RCT
Page 16 and 17: Regional anaesthesia* and chronic p
Page 18 and 19: Rowbotham D J Improves quality of o
Page 20 and 21: Anesth Analg 2004;99:482-9595 37 RC
Page 23: NewsweekApril 14, 2008
Page 27 and 28: About 55 000 unnecessary C. Section
Page 29 and 30: APS - Örebro modelPre-set goals•
Page 31 and 32: To summarize...
Page 34 and 35: Chronic postsurgical painGenetic pr
Page 36 and 37: Persistent postsurgical painSummary
Page 40 and 41: RCT, colon surgery, n = 85, 72 hour
Page 42: Brennan T J, Kehlet HIn summary…

Professor Narinder Rawal, MD, PhD, FRCA (Hon) - AKUTNE.CZ

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