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General anesthesia used in surgery can increase post-op pain by activating body’s chemical irritant response, Georgetown researchers discover

  [ 125 votes ]   [ 4 Comments ]
www.ProHealth.com • July 11, 2008


“The choice of anesthetic appears to be an important determinant of post-operative pain.” Gerard Ahern, PhD, Georgetown University Dept. of Pharmacology

Washington, D.C. - The general anesthesia that puts patients into unconscious sleep so they do not feel surgical pain can increase the discomfort they feel once they wake up, say researchers from Georgetown University Medical Center. They say their findings, the first to scientifically explain what has been anecdotally observed in the clinic, may lead to wider use of the few anesthetics that don’t have this side effect, or to the development of new ones.

In the June 24 issue of the Proceedings of the National Academy of Sciences (PNAS)1 the scientists report that “noxious” anesthesia drugs - which most of these general anesthetics are - activate and then sensitize specific receptors on neurons in the peripheral nervous system. These are the sensory nerves in the inflammation and pain pathway that are not affected by general anesthesia drugs that target the central nervous system – the brain and the spinal cord.

“The choice of anesthetic appears to be an important determinant of post-operative pain,” says the study’s lead investigator, Gerard Ahern, PhD, an assistant professor in the Department of Pharmacology at Georgetown University Medical Center. “We hope these findings are ultimately helpful in providing more comfort to patients.”

  • It has long been known that general anesthetics cause irritation at the infusion site or in the airways when inhaled, Dr. Ahern says.
  • And investigators have also known that while they suppress the central nervous system, they can activate so called “pain-sensing” or nociceptive nerve cells on the peripheral nervous system.
  • In fact, anesthesiologists often first use a drug to suppress inflammation and pain before delivering the anesthesia to put the patient to sleep.
  • But what has not been understood is the specific mechanism by which anesthetics affect sensory neurons, or that they can continue to cause pain and inflammation even as they are being used during surgery, Dr. Ahern says.

The Hypothesis

The researchers tested the hypothesis that two specific receptors on the nerve cells (TRPV1 and TRPA1) which are often expressed together and which also react to other irritants, such as garlic and wasabi, were the ones activated by the noxious drugs.

“Plants produce chemicals such as capsaicin, mustard and garlic that were meant to stop animals from eating them. When they are eaten, the two main receptors that react to them are TRPV1 and TRPA1,” Dr. Ahern says. In fact, TRPA1 is more commonly known as the mustard-oil receptor, and is a principal receptor in the pain pathway, he says.

The Findings

Experiments showed that general anesthetics appear to regulate TRPA1 in a direct fashion, and are thus responsible for the acute noxious effects of the drugs. Perhaps the strongest evidence is that mice bred without TRPA1 genes demonstrate no pain when the drugs are administered and used, Ahern says.

“Most general anesthetics activate the mustard oil receptor, and animals that don’t have the receptor don’t have irritation,” he says.

The research team also found that nerve-mediated inflammation was greater when pungent (chemical irritants) versus non-pungent inhaled general anesthetics were used.

The Implications

What both findings suggest is that sensory nerve stimulation throughout the body just before and during surgery adds to the pain that is felt after the patient is awake, Ahern says.

“This is a provocative finding in terms of the clinical setting, because it was not really recognized that use of these drugs results in release of lots of chemicals that recruit immune cells to the nerves, which causes more pain or inflammation.”

Some general anesthetics do not activate the mustard-oil receptor, but they may not be as effective in other ways, Ahern says. “This tells us that there is room for improvement in these drugs.”

The study was funded by National Institutes of Health and the National Multiple Sclerosis Society. Co-authors include José Matta, PhD, Paul Cornett, PhD, Rosa Miyares, BA, Ken Abe, PhD, and Niaz Sahibzada, PhD, from Georgetown University.

____
1. See “General anesthetics activate a nociceptive ion channel to enhance pain and inflammation,” PNAS (Proceedings of the National Academy of Sciences) June 24; 105:8784-8789. PMID: 18574153, by Ahern GP, Matta JA, et al. [E-mail: Gerard P Ahern gpa3@georgetown.edu]

Source: Georgetown University Medical Center news release, June 23, 2008

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any disease. It is very important that you make no change in your healthcare plan without researching and discussing it in collaboration with your professional healthcare team.




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Article Comments Post a Comment

General anesthesia and post-op pain
Posted by: Rainmaker
Jul 16, 2008
Does any of this relate specifically to ME/CF? Recently I had an out-patient operation on my eyelids for ptosis. Not a very earth-shaking event, and I was only under general anesthetic for a few minutes. However after that operation my general health and CF went downhill; In addition I developed macular degeneration and the beginning of cataracts. It's been well over a year now and I'm still struggling to get back uphill. Should doctors who are doing operations on CF patients be held responsible for knowing about possible reprocussions? If we sued a few of them (which I am not going to do) would that help make them study up on CF and take it more seriously?
Reply Reply

Anesthesia and post-op nerve inflammation
Posted by: ddt
Jul 23, 2008
With CFS, are the nerves more prone to inflammation? I believe this happened to me months ago, and I'm still feeling the affects. In April I had a colonoscopy and upper GI endoscopy. They used a lot of anesthesia. The next day i began having extreme numbness and tingling in my extremities. My right hand is especially bad when i move my neck in certain positions, leading me to believe they pinched a nerve. But i also intuitionally felt the anesthesia caused some nerve inflammation. It seems logical since i already have nerve sensitivity. This article may confirm my intuition. My numbness has lessened slightly, but from now on i will try to get the names of which anesthesia is more likely to cause this.
Reply Reply

 
Post-op nerve pain from One year... maybe from overdose of Anesthesia?
Posted by: problemman
Nov 10, 2008
I had gynecomastia surgery(liposuction+gland excision) 1 year back. Since the surgery, i am experiencing terrible burning pain 4 inches down the left armpit, which radiates to left hand, shoulder, left chest, upper back and leg. From 7 months i have pain in my left part of neck as well. Recently i have pain in left scrotum, left face, ear and head. Totally i can say, the pain has spread to the entire left body. Right side is perfectly normal.

So, finally i consulted a Neurophysician. The mri's of brain and cervical spine show no signs of any problems. I'm taking some meds for nerve pain but i see no change.

Now, i am guessing if Anesthesia could have contributed to post-op nerve pain. Is there any medical test to confirm this? One of my aunt has similar problems after delivery of her 3rd child. so since 20 years she is having similar symptoms which i have mentioned above. It is confirmed that overdoes of Anesthesia has caused this. I can't discuss my case with ther cuz my surgery was a secret.

Is there any permanent treatment for this bad pain? What should be my next step?

 


Post-op nerve pain from One year... maybe from overdose of Anesthesia?
Posted by: problemman
Nov 10, 2008
I had gynecomastia surgery(liposuction+gland excision) 1 year back. Since the surgery, i am experiencing terrible burning pain 4 inches down the left armpit, which radiates to left hand, shoulder, left chest, upper back and leg. From 7 months i have pain in my left part of neck as well. Recently i have pain in left scrotum, left face, ear and head. Totally i can say, the pain has spread to the entire left body. Right side is perfectly normal. So, finally i consulted a Neurophysician. The mri's of brain and cervical spine show no signs of any problems. I'm taking some meds for nerve pain but i see no change. Now, i am guessing if Anesthesia could have contributed to post-op nerve pain. Is there any medical test to confirm this? One of my aunt has similar problems after delivery of her 3rd child. so since 20 years she is having similar symptoms which i have mentioned above. It is confirmed that overdoes of Anesthesia has caused this. I can't discuss my case with ther cuz my surgery was a secret. Is there any permanent treatment for this bad pain? How to confirm whether the pain is from Anesthesia? What should be my next step?
Reply Reply


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