辅助剂复合局麻药行周围神经阻滞的应用及发展趋势

doi:10.3760/cma.j.issn.1007-1245.2022.23.024

摘要/Abstract

摘要： 周围神经阻滞（PNB）是临床麻醉和疼痛治疗中常用的方法。单独用局麻药实施PNB，其镇痛维持时间常常难以满足临床需求。临床上通过应用辅助剂复合局麻药可改善镇痛效果，比较常用的有阿片类、α-2肾上腺素能受体激动剂、类固醇等。在应用这些辅助剂时，必须对其作用机制、临床应用优势及局限性等有足够的了解，以便在PNB应用时做出更佳的选择。

关键词: 周围神经阻滞, 镇痛, 局麻药, 辅助剂

Abstract: Peripheral nerve block (PNB) is commonly used in surgical anesthesia and pain treatment. The length of analgesia when a single local anesthetic is used may not last long enough to satisfy clinical need. Adding adjuvants, such as opioids, α-2 agonist, steroids, and so on, may prolong analgesic effect. It is important to acquaintance the action mechanism, advantages, and limitations of these adjuvants to make better clinical choices in PNB.

Key words: Peripheral nerve block, Anesthesia, Local anesthetics, Adjuvants

潘志豪于凯华王波鞠衍馨. 辅助剂复合局麻药行周围神经阻滞的应用及发展趋势[J]. 国际医药卫生导报, 2022, 28(23): 3355-.

Pan Zhihao, Yu Kaihua, Wang Bo, Ju Yanxin. Recent progress of adjuvants to local anesthetics in peripheral nerve block[J]. International Medicine and Health Guidance News, 2022, 28(23): 3355-.

参考文献

[1] Hussain N, McCartney CJL, Neal JM, et al. Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review and empirical analysis[J]. Br J Anaesth, 2018, 121(4):822-841. DOI: 10.1016/j.bja.2018.05.076.
[2] Swain A, Nag DS, Sahu S, et al. Adjuvants to local anesthetics: current understanding and future trends [J]. World J Clin Cases, 2017, 5: 307. DOI: 10.12998/wjcc.v5.i8.307.
[3] Opperer M, Gerner P, Memtsoudis SG. Additives to local anesthetics for peripheral nerve blocks or local anesthesia: a review of the literature [J]. Pain Manag. 2015, 5: 117-128. DOI: 10.2217/pmt.15.2.
[4] Bazin JE, Massoni C, Bruelle P, et al. The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil [J]. Anaesthesia, 1997, 52:858-862. DOI: 10.1111/j.1365-2004.1997.174-az0311.x.
[5] Rienk van B, Harry JZ, Tjeerd van der P, et al. In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage: a prospective, double-blinded, randomized, placebo controlled trial [J]. Medicine(Baltimore), 2017, 96(27): e7393. DOI: 10.1097/MD.0000000000007393.
[6] Karaman S, Kocabas S, Uyar M, et al. The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for Caesarean section [J]. Eur J Anaesthesiol, 2006, 23: 285-291. DOI: 10.1017/s0265021505001869.
[7] Axelsson K, Johanzon E, Essving P, et al. Postoperative extradural analgesia with morphine and ropivacaine. A double-blind comparison between placebo and ropivacaine 10 mg/h or 16 mg/h [J]. Acta Anaesthesiol Scand, 2005, 49: 1191-1199. DOI: 10.1111/j1399-6576.2005.00715.x.
[8] Fatma AE, Sahar AM, Shereen MK. The effect of morphine added to bupivacaine in ultrasound guided transversus abdominis plane (TAP) block for postoperative analgesia following lower abdominal cancer surgery, a randomized controlled study [J]. Clin Anesth, 2017, 39: 4-9. DOI: 10.1016/j.jclinane.2017.03.009.
[9] Hala AG, Fatma GE, Huda HM, et al. Analgesic and respiratory effects of two doses of morphine as an adjunct to bupivacaine in ultrasound-guided transversus abdominis plane block in upper abdominal surgery [J]. Pain Physician, 2019, 22(5):509-517.
[10] Bhuvaneswari V, Wig J, Mathew PJ, et al. Post-operative pain and analgesic requirements after paravertebral block for mastectomy: a randomized controlled trial of different concentrations of bupivacaine and fentanyl [J]. Indian J Anaesth, 2012, 56: 34-39. DOI: 10.4103/009-5046.93341.
[11] Sindjelic RP, Vlajkovic GP, Davidovic LB, et al. The addition of fentanyl to local anesthetics affects the quality and duration of cervical plexus block: a randomized, controlled trial [J]. Anesth Analg, 2010, 111(1): 234-237. DOI: 10.1213/ANE.0b013e3181e1e9ab.
[12] Gunn HK, Joon WL, Go EK, et al. Analgesic effect of ropivacaine with fentanyl in comparison with ropivacaine alone for continuous femoral nerve block after knee replacement arthroplasty: a prospective, randomized, double-blinded study [J]. Anesth Pain Med(Seoul), 2020, 15(2):209-216. DOI: 10.17085/apm.2020.15.2.209.
[13] Christian B, Iaabelle P, Catherine M, et al. Adding sulfentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: a randomised controlled trial [J]. Eur J Anaesthesiol, 2018, 35(10): 766-773. DOI: 10.1097/EJA.0000000000000777.
[14] Hye WS, Bum JJ, Yoo KJ, et al. Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: a systematic review and meta-analysis [J]. Plos One, 2017, 12(9): E0184649. DOI: 10.1371/JOURNAL.PONE.0184649.
[15] Kesimci E, Izdes S, Gozdemir M, et al. Tramadol does not prolong the effect of ropivacaine 7.5 mg/ml for axillary brachial plexus block [J]. Acta Anaesthesiol Scand, 2007, 51: 736-741. DOI: 10.1111/j.1399-6576.2007.01308.x.
[16] Prakash K, Jamkar MA. Evaluation of clonidine as an adjuvant to brachial plexus block and its comparison with tramadol [J]. J Anesthesiol Clin Pharmacol, 2017, 33(2):197-202. DOI: 10.4103/joacp.JOACP_58_13.
[17] Kroin JS, Buvanendran A, Beck DR, et al. Clonidine prolongation of lidocaine analgesia after sciatic nerve block in rats is mediated via the hyperpolarization-activated cation current, not by alpha-adrenoreceptors [J]. Anesthesiology, 2004, 101:488-494. DOI: 10.1097/00000542-200408000-00031.
[18] Fournier R, Faust A, Chassot O, et al. Perineural clonidine does not prolong levobupivacaine 0.5% after sciatic nerve block using the Labat approach in foot and ankle surgery [J]. Reg Anesth Pain Med, 2012, 37:521-524. DOI: 10.1097/AAP.0b013e3182606168.
[19] Jarraya A, Smaoui M, Abidi S, et al. The analgesic effect of clonidine as an adjuvant in dorsal penile nerve block [J]. Pan Afr Med J, 2016, DOI: 10.11604/PAMJ.2016. 23.213.5767.
[20] Dogru K. Hemodynamic and blockade effects of high/low epinephrine doses during axillary brachial plexus blockade with lidocaine 1.5%: a randomized, double-blinded study [J]. Reg Anesth Pain Med, 2003, 28: 401-405. DOI: 10.1016/s1098-7399(03)00225-6.
[21] 张德凤, 谭永星.右美托咪定作为佐剂在围术期周围神经阻滞中的应用进展[J]. 国际医药卫生导报, 2021, 27(13): 2035-2039. DOI: 10.3760/cma.j.issn.1007-1245.2021. 13.034.
[22] Srikantha Rao, Niraja Rajan. Dexmedetomidine as an adjunct for regional anesthetic nerve blocks [J]. Curr Pain Headache Rep.2021,25(2):8. DOI:10.1007/s11916-020-00926-z.
[23] Zhao XY, Zhang EF, Bai XL, et al. Ultrasound-guided continuous femoral nerve block with dexmedetomidine combined with low concentrations of ropivacaine for postoperative analgesia in elderly knee arthroplasty[J]. Med Princ Pract,2019,28(5):457-462. DOI:10.1159/000500261.
[24] Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials [J]. Br J Anaesth, 2017, 118(2):167-181. DOI: 10.1093/bja/aew411.
[25] Zhang H, Zhou F, Li C, et al. Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: an in vivo and in vitro experimental study [J]. PLoS One, 2013, 8: e55556. DOI: 10.1371/journal.pone.0055556.
[26] Song ZG, Pang SY, Wang GY, et al. Comparison of postoperative analgesic effects in response to either dexamethasone or deximedetomidine as local anesthetic adjuvants: a systematic review and meta-analysis of randomized controlled trials [J]. J Anesth, 2021, 35(2): 270-287. DOI: 10.1007/s00540-021-02895-y.
[27] Parrington SJ, O'Donnell D, Chan VW, et al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade [J]. Reg Anesth Pain Med, 2010, 35: 422-426. DOI: 10.1097/AAP.0b013e3181e85eb9.
[28] Eker HE, Cok OY, Aribogan A, et al. Management of neuropathic pain with methylprednisolone at the site of nerve injury [J]. Pain Med, 2012, 13: 443-451. DOI: 10.1111/j.1526-4637.2011.01323.x.
[29] Routray SS, Mishra D, Routray D, et al. Effect of verapamil as an adjuvant to levobupivacaine in supraclavicular brachial plexus block [J]. Anesth Essays Res, 2017, 11: 656-660. DOI: 10.4103/aer.AER_19_17.
[30] Lee IO, Kim WK, Kong MH, et al. No enhancement of sensory and motor blockade by ketamine added to ropivacaine interscalene brachial plexus blockade [J]. Acta Anaesthesiol Scand, 2002, 46: 821-826. DOI:10.1034/j.1399-6576.2002460711.x
[31] Demirel E, Ugur HC, Dolgun H, et al. The neurotoxic effects of intrathecal midazolam and neostigmine in rabbits [J]. Anaesth Intensive Care, 2006, 34: 218-223. DOI: 10.1177/0310057x0603400204.
[32] Lee AR, Yi HW, Chung IS, et al. Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block [J]. Can J Anaesth J Can Anesth, 2012, 59: 21-27. DOI:10.1007/s12630-011-9604-5.
[33] Chawki J, Mohamed K, Nesrine IH, et al. Magnesium sulfate as adjuvant in prehospital fermoral nerve block for a patient with diaphysial femoral fracture: a randomized controlled trial [J]. Pain Res Manag, 2018: 2926404. DOI: 10.1155/2018/2926404.
[34] Dogru K, Yildirim D, Ulgey A, et al. Adding magnesium to levobupivacaine for axillary brachial plexus block in arteriovenous fistule surgery [J]. Bratisl Lek Listy, 2012, 113: 607-609. DOI:10.4149/bll-2012-136.