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La douleur chronique post-chirurgicale pp 65–83Cite as

Mononeuropathies induites par la chirurgie : de l’anatomie à la prévention

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Résumé

Si l’on peut supposer raisonnablement que certaines chirurgies induisent des lésions nerveuses périphériques (cf. infra), on connaît en revanche très mal la nature exacte des lésions. Les gestes pratiqués en cours de chirurgie sont en faveur de trois types de lésions possibles:

  • — la section d’une branche terminale de petite taille, le chirurgien évitant a priori de léser ce qui lui est évident visuellement ; cette section peut générer un névrome inducteur de douleur provoquée et/ou une sensation de «pièce manquante fantôme» liée à la déafférentation;

  • — l’écrasement: c’est ce qui est classiquement observé en cours de thoracotomie [1] ;

  • — le «piégeage» (entrapment) du nerf lors de la cicatrisation, notamment au sein de la fibrose réactionnelle.

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  1. Centre de pharmacologie clinique, Inserm, CHU de Clermont-Ferrand, CIC 501 et U1107 «Neuro-Dol», 63003, Clermont-Ferrand Cedex 01, France

    C. Dualé

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Dualé, C. (2013). Mononeuropathies induites par la chirurgie : de l’anatomie à la prévention. In: La douleur chronique post-chirurgicale. Springer, Paris. https://doi.org/10.1007/978-2-8178-0026-4_5

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  • DOI: https://doi.org/10.1007/978-2-8178-0026-4_5

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