RESEARCH ARTICLE


C-fiber-Selective Peripheral Nerve Blockade



Suzuko Suzuki1, *, Peter Gerner2, Anna C Colvin3, Alexander M. Binshtok4
1 Department of Anesthesiology and Perioperative Medicine, Pain Research Center, Brigham and Women's Hospital,MRB-611 75 Francis Street, Boston, MA 02115
2 Department of Anesthesiology, Perioperative, and Pain Medicine,Brigham and Women's Hospital and Harvard Medical School, Boston, MA
3 Department of Anesthesiology,Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard, Medical School, Boston, MA
4 Department of Anesthesia, and Critical Care, Massachusetts General Hospital and Harvard, Medical School,Charlestown, MA


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© 2009 Suzuki et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anes- thesiology and Perioperative Medicine, Pain Research Center, Brigham and Women's Hospital, MRB-611 75 Francis Street, Boston, MA 02115; E-mail: ssuzuki@zeus.bwh.harvard.edu


Abstract

Despite the clinical demand, current uses of local anesthetics do not allow selective blockade of nociceptive fibers. Regional anesthesia produces an analgesic effect accompanied with undesired side effects due to block of motor, non-nociceptive sensory and autonomic fibers. These side effects limit the clinical use of local anesthetics and affect the recovery and rehabilitation period after surgical procedures. Therefore one main goal of research in the field of regional anesthesia is selectively targeting nociceptive fibers. Recent studies describing the role of nociceptive specific sodium channels in generation and propagation of nociceptive signals make these channels ideal targets for pain selective blockade. In addition, novel methods of targeted delivery of charged local anesthetics selectively into nociceptors provide another potentially successful approach for c-fiber specific nerve block. This review summarizes currently on-going studies on several promising targets and methods to achieve pain selective anesthesia.