“These [long-term developmental] effects are independent of the anesthetic exposure and highlight the reemerging concept of surgery and pain as an ‘exposure’ that results in long-term changes in the developing nervous system ...”
What are the implications for children having surgery? Do genetics play a role? What is the role of different anesthetics during the most profound nociceptive barrage? Should nerve block be used? How long?
What is the effect of postoperative analgesic regimens? Is an adequate analgesic regimen enough to prevent the effects of incision? What is the role of nonsteroidal antiinflammatory drugs or narcotics?
Does reduced sensory capability affect performance in fine functioning motor and sensory skills? Or is it protective as an adaptive response?
Does the increased inflammatory cell activation from re-exposure occur only in the central nervous system, or does it occur elsewhere resulting in reduced recovery and/or prolonged pain? Or does it actually accelerate healing later?
Is it previous surgery and neural input alone, or does any type of inflammatory response produce similar changes, globally and more specifically in the spinal cord and peripheral neurons? Do the changes in neuroinflammatory responses result in changes in susceptibility and risk from large inflammatory response injuries such as trauma and sepsis in later life?
Douglas G. Ririe; How Long Does Incisional Pain Last: Early Life Vulnerability Could Make It Last a Lifetime. Anesthesiology 2015;122(6):1189-1191. doi: https://doi.org/10.1097/ALN.0000000000000660.
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