Analgesia is a pain-free state, whereas anesthesia is a state achieved when there is a loss of touch, pain, and temperature sensations with or without loss of consciousness. Anesthesia is associated with some degree of analgesia but not vice versa. What then differentiates a state of sleep from anesthesia? One can be awakened from a sleep state, whereas someone under general anesthesia has to be monitored carefully for a few hours and recovers only after the effect of the anesthetic agent wears off.

Most over-the-counter analgesics are oral, whereas anesthetics are available as topical, injectable, and inhaled formulations. Relieving pain has been shown to result in improved healing, faster recovery, and an earlier return to former activities and lifestyle.

Mechanism of Action of Analgesics and Anesthetics

The most widely used class of analgesics, namely, NSAIDs, work by blocking the synthesis of prostaglandins, which are key mediators of the inflammatory process. This mechanism, in turn, helps reduce the stimulation of free nerve endings and blocks the transmission of pain signals. Opioids, on the other hand, acts on both the peripheral nerves and the brain and alter pain perception.

When local anesthetics are injected around a nerve, they block the sodium channels present on the nerve. This blocking effect is voltage-dependent, which means that thin nerve fibres that conduct signals faster, such as the pain fibres, are blocked significantly more effectively than larger nerves.

General anesthetics can be administered as a gas or intravenously. They produce a loss of pain, touch, temperature, and reflexes accompanied by loss of memory and consciousness. General anesthetics depress the central nervous system mainly through their effects on the inhibitory neurotransmitter GABA.

Combining Analgesia and Anesthesia

General anesthetics are rarely administered as sole agents for complex operative procedures. A combination of adjuvants, such as analgesics and/or skeletal muscle relaxants, are co administered to achieve the desired state of surgical anesthesia.

Local and regional anesthesia can be used as an alternative or in addition to conventional pain control during and after surgery and the immediate period after childbirth.

Analgesic opioids given as regional analgesia and intravenous patient-controlled analgesia (PCA) have demonstrated effective control of postoperative pain.

Epidural analgesia can also be used as the sole anesthetic agent for surgeries and can be used as the primary anesthetic for surgeries from the chest to the lower extremities. This method of combining opioid/non-opioid analgesics with anesthesia helps reduce the pain along with the dose and side effects of opioid analgesics, such as nausea, vomiting, slowing of bowel movements leading to constipation, and sedation.

Current Issue: Volume 3: Issue 2

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Anesthesiology Case Reports