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On-line version ISSN 1806-907X
Rev. Bras. Anestesiol. vol.57 no.6 Campinas Nov./Dec. 2007
LETTER TO THE EDITOR
To the Editor,
We would like to thank the important anatomic comments of Otto Geier regarding our study on postoperative analgesia in living beings 1. Many of his continuous and repetitive questions have already been answered 2 in other considerations 3. Therefore, the patient might have decreased sensitivity on a given area and at the same time complain of pain. This must be the discrepancy that Geier found in the tables he mentioned. Scientific truth does not exist: there is only scientific knowledge, always relative, always approximated, always provisory, always somewhat doubtful or subjected to caution. We know that every subject has arguments to the contrary.
Every living organism has abundant riches, an infinite complexity and, despite of it, life can be simple. Is there anything more complicated than a tree when we try to understand its inner functioning? And is there anything simpler when we just observe it? Is there anything more complex than an eye? Is there anything simpler than seeing? This is life itself: complexity at the service of simplicity. And pain? How complex is its mechanism? How many pathways? Activation, modulation, descending pathways, ascending pathways, etc. How many modulators? Serotonin, opioids, adenosine, cholinergics, muscarinic, substance P, etc. How many sites of action? Cortex, thalamus, midbrain, medulla, spinal cord. How many receptors? Mu, delta, kappa, alpha1, alpha 2, adenosine 1, etc. But how simple it is for the patient to complain of pain. Once more we have complexity serving simplicity. But when it comes to understand or to explain it, we cannot avoid complexity. But understanding is not everything, and it is not the ultimate purpose.
To finalize, we understand that Geier wants to explain the complexity of pain in patients who underwent major orthopedic surgeries, while we only want the simplicity of analgesia.
Luiz Eduardo Imbelloni,
José Antônio Cordeiro
01. Imbeloni LE, Beato L, Beato C et al. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: Comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal. Rev Bras Anestesiol, 2006;56:619-629.
02. Imbelloni LE Bloqueio 3 em 1 com bupivacaína 0,25% para analgesia pós-operatória em cirurgias ortopédicas (Réplica). Rev Bras Anestesiol, 2001;51:177-179.
03. Geier KO Bloqueio 3 em 1 com bupivacaína 0,25% para analgesia pós-operatória em cirurgias ortopédicas (Carta ao Editor). Rev Bras Anestesiol, 2001;51:176-177.