Effect of local anesthetics on the prevention and treatment of chronic post-surgical pain

Despite researches that have been thoroughly done on the mechanism of pain and the appeals for standardized management of pain, the high incidence of chronic post-surgical pain(CPSP) is still a serious problem in clinical work. The problem remains particularly in certain types of surgery as amputation(30%-50%), breast cancer surgery(20%-30%) and thoracotomy(30%-60%), among which 2%-10% patients have suffered from severe CPSP and even lost their ability to live and work. CPSP often develops from severe acute post-surgical pain, accompanied by a complex pathological process after surgical trauma. Therefore, a rational and effective perioperative analgesia management of acute post-surgical pain is real important for reducing CPSP. Local anesthetics, which can reversibly block the conduction of nerve impulse,are widely used in clinical practice to treat postoperative pain for its safety and efficacy. Growing evidences show that peripheral and central sensitization caused by nerve injury during operation and inflammation after operation are vital factors in pathophysiology and development of CPSP. The pharmacological properties of local anesthetics in blocking signal transduction and anti-inflammatory are closely connected with the mechanism of CPSP. This article reviews the main pharmacologic properties of local anesthetics in treating CPSP, discusses the future broad application as well as the limits of local anesthetics and considers better strategies to help treat CPSP.