局部麻醉辅助用药的研究进展_West China Medical Journal

Authors：

 钱朵 ,  张文胜

四川大学华西医院麻醉科（成都，610041）;

Corresponding author：

张文胜, Email: realzws@163.com

Keywords：

局部麻醉药; 辅助; 周围神经; 鞘内注射; 效果

DOI：

10.7507/1002-0179.20140486

Video：

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局部麻醉药在临床上被广泛应用，但在实际应用中总会产生各种无法避免的毒副作用。近年来相关研究通过加入各种辅助药物使局部麻醉药的毒副作用减轻且增强其麻醉效果，由于每一种辅助药物与局部麻醉药配伍各有其优缺点，寻找起效时间短、作用时间长、感觉运动分离且不良反应少的配伍药物参与的局部麻醉效果，有待大家进一步的努力。现就该领域的最新研究进展作一阐述。

Citation： 钱朵, 张文胜. 局部麻醉辅助用药的研究进展. West China Medical Journal, 2014, 29(8): 1589-1592. doi: 10.7507/1002-0179.20140486 Copy

1.	Niemi G, Breivik H. Epinephrine markedly improves thoracic epidural analgesia produced by a small-dose infusion of ropivacaine, fentanyl, and epinephrine after major thoracic or abdominal surgery:a randomized, double-blinded crossover study with and without epinephrine[J]. Anesth Analg, 2002, 94(6):1598-1605.
2.	Gurbet A, Turker G, Kose DO, et al. Intrathecal epinephrine in combined spinal-epidural analgesia for labor:dose-response relationship for epinephrine added to a local anesthetic-opioid combination[J]. Int J Obstet Anesth, 2005, 14(2):121-125.
3.	Goodman SR, Kim-Lo SH, Ciliberto CF, et al. Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia[J]. Reg Anesth Pain Med, 2002, 27(4):374-379.
4.	Goyagi T, Nishikawa T. The addition of epinephrine enhances postoperative analgesia by intrathecal morphine[J]. Anesth Analg, 1995, 81(3):508-513.
5.	Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems:neurotoxicity and neural blood flow[J]. Reg Anesth Pain Med, 2003, 28(2):124-134.
6.	Elia N, Culebras X, Mazza C, et al. Clonidine as an adjuvant to intrathecal local anesthetics for surgery:systematic review of randomized trials[J]. Reg Anesth Pain Med, 2008, 33(2):159-167.
7.	Thakur A, Bhardwaj M, Kaur K, et al. Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy:a randomized double-blinded study[J]. J Anaesthesiol Clin Pharmacol, 2013, 29(1):66-70.
8.	Mccartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature[J]. Reg Anesth Pain Med, 2007, 32(4):330-338.
9.	Butterworth JF, Strichartz GR. The alpha 2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers[J]. Anesth Analg, 1993, 76(2):295-301.
10.	Swami SS, Keniya VM, Ladi SD, et al. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block:a randomised double-blind prospective study[J]. Indian J Anaesth, 2012, 56(3):243-249.
11.	Marhofer D, Kettner SC, Marhofer P, et al. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J]. Br J Anaesth, 2013, 110(3):438-442.
12.	Gupta R, Verma R, Bogra J, et al. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine[J]. J Anaesthesiol Clin Pharmacol, 2011, 27(3):339-343.
13.	Pöpping DM, Elia N, Wenk M, et al. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid:a meta-analysis of randomized trials[J]. Pain, 2013, 154(8):1383-1390.
14.	Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia[J]. Anesth Analg, 2008, 107(3):1026-1040.
15.	Murphy DB, Mccartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block:a systematic review[J]. Anesth Analg, 2000, 90(5):1122-1128.
16.	Vieira PA, Pulai I, Tsao GC, et al. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade[J]. Eur J Anaesthesiol, 2010, 27(3):285-288.
17.	Bani-Hashem N, Hassan-Nasab B, Pour EA, et al. Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in orthopedic surgery[J]. Saudi J Anaesth, 2011, 5(4):382-386.
18.	Bernatzky G, Jurna I. Intrathecal injection of codeine, buprenorphine, tilidine, tramadol and nefopam depresses the tail-flick response in rats[J]. Eur J Pharmacol, 1986, 120(1):75-80.
19.	Altunkaya H, Ozer Y, Kargi E, et al. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures[J]. Br J Anaesth, 2003, 90(3):320-322.
20.	Robaux S, Blunt C, Viel E, et al. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently[J]. Anesth Analg, 2004, 98(4):1172-1177.
21.	Alhashemi JA, Kaki AM. Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate[J]. Br J Anaesth, 2003, 91(4):536-540.
22.	Frikha N, Ellachtar M, Mebazaa MS, et al. Combined spinal-epidural analgesia in labor-comparison of sufentanil vs tramadol[J]. Middle East J Anesthesiol, 2007, 19(1):87-96.
23.	Faiz SH, Rahimzadeh P, Sakhaei MA, et al. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries[J]. J Res Med Sci, 2012, 17(10):918-922.
24.	Ho KM, Ismail H, Lee KC, et al. Use of intrathecal neostigmine as an adjunct to other spinal medications in perioperative and peripartum analgesia:a meta-analysis[J]. Anaesth Intensive Care, 2005, 33(1):41-53.
25.	Bone HG, Van Aken H, Booke M, et al. Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine[J]. Reg Anesth Pain Med, 1999, 24(5):405-410.
26.	Van Elstraete AC, Pastureau F, Lebrun T, et al. Neostigmine added to lidocaine axillary plexus block for postoperative analgesia[J]. Eur J Anaesthesiol, 2001, 18(4):257-260.
27.	Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy[J]. Br J Anaesth, 2001, 86(1):77-79.
28.	Shadangi BK, Garg R, Pandey R, et al. Effects of intrathecal midazolam in spinal anaesthesia:a prospective randomised case control study[J]. Singapore Med J, 2011, 52(6):432-435.
29.	Jarbo K, Batra YK, Panda NB. Brachial plexus block with midazolam and bupivacaine improves analgesia[J]. Can J Anaesth, 2005, 52(8):822-826.
30.	Choudhuri AH, Dharmani P, Kumarl N, et al. Comparison of caudal epidural bupivacaine with bupivacaine plus tramadol and bupivacaine plus ketamine for postoperative analgesia in children[J]. Anaesth Intensive Care, 2008, 36(2):174-179.
31.	Elia N, Tramèr MR. Ketamine and postoperative pain:a quantitative systematic review of randomised trials[J]. Pain, 2005, 113(1/2):61-70.
32.	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(7):821-826.
33.	Berde CB, Athiraman U, Yahalom BA, et al. Tetrodotoxin-bupivacaine-epinephrine combinations for prolonged local anesthesia[J]. Mar Drugs, 2011, 9(12):2717-2728.
34.	Binshtok AM, Bean BP, Woolf CJ. Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers[J]. Nature, 2007, 449(7162):U13-607.
35.	Ries CR, Pillai R, Chung CC, et al. QX-314 produces long-lasting local anesthesia modulated by transient receptor potential vanilloid receptors in mice[J]. Anesthesiology, 2009, 111(1):122-126.
36.	Shen J, Fox LE, Cheng J. Differential effects of peripheral versus central coadministration of QX-314 and capsaicin on neuropathic pain in rats[J]. Anesthesiology, 2012, 117(2):365-380.
37.	Wang CF, Gerner P, Schmidt B, et al. Use of bulleyaconitine A as an adjuvant for prolonged cutaneous analgesia in the rat[J]. Anesth Analg, 2008, 107(4):1397-1405.

1. Niemi G, Breivik H. Epinephrine markedly improves thoracic epidural analgesia produced by a small-dose infusion of ropivacaine, fentanyl, and epinephrine after major thoracic or abdominal surgery:a randomized, double-blinded crossover study with and without epinephrine[J]. Anesth Analg, 2002, 94(6):1598-1605.
2. Gurbet A, Turker G, Kose DO, et al. Intrathecal epinephrine in combined spinal-epidural analgesia for labor:dose-response relationship for epinephrine added to a local anesthetic-opioid combination[J]. Int J Obstet Anesth, 2005, 14(2):121-125.
3. Goodman SR, Kim-Lo SH, Ciliberto CF, et al. Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia[J]. Reg Anesth Pain Med, 2002, 27(4):374-379.
4. Goyagi T, Nishikawa T. The addition of epinephrine enhances postoperative analgesia by intrathecal morphine[J]. Anesth Analg, 1995, 81(3):508-513.
5. Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems:neurotoxicity and neural blood flow[J]. Reg Anesth Pain Med, 2003, 28(2):124-134.
6. Elia N, Culebras X, Mazza C, et al. Clonidine as an adjuvant to intrathecal local anesthetics for surgery:systematic review of randomized trials[J]. Reg Anesth Pain Med, 2008, 33(2):159-167.
7. Thakur A, Bhardwaj M, Kaur K, et al. Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy:a randomized double-blinded study[J]. J Anaesthesiol Clin Pharmacol, 2013, 29(1):66-70.
8. Mccartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature[J]. Reg Anesth Pain Med, 2007, 32(4):330-338.
9. Butterworth JF, Strichartz GR. The alpha 2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers[J]. Anesth Analg, 1993, 76(2):295-301.
10. Swami SS, Keniya VM, Ladi SD, et al. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block:a randomised double-blind prospective study[J]. Indian J Anaesth, 2012, 56(3):243-249.
11. Marhofer D, Kettner SC, Marhofer P, et al. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J]. Br J Anaesth, 2013, 110(3):438-442.
12. Gupta R, Verma R, Bogra J, et al. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine[J]. J Anaesthesiol Clin Pharmacol, 2011, 27(3):339-343.
13. Pöpping DM, Elia N, Wenk M, et al. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid:a meta-analysis of randomized trials[J]. Pain, 2013, 154(8):1383-1390.
14. Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia[J]. Anesth Analg, 2008, 107(3):1026-1040.
15. Murphy DB, Mccartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block:a systematic review[J]. Anesth Analg, 2000, 90(5):1122-1128.
16. Vieira PA, Pulai I, Tsao GC, et al. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade[J]. Eur J Anaesthesiol, 2010, 27(3):285-288.
17. Bani-Hashem N, Hassan-Nasab B, Pour EA, et al. Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in orthopedic surgery[J]. Saudi J Anaesth, 2011, 5(4):382-386.
18. Bernatzky G, Jurna I. Intrathecal injection of codeine, buprenorphine, tilidine, tramadol and nefopam depresses the tail-flick response in rats[J]. Eur J Pharmacol, 1986, 120(1):75-80.
19. Altunkaya H, Ozer Y, Kargi E, et al. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures[J]. Br J Anaesth, 2003, 90(3):320-322.
20. Robaux S, Blunt C, Viel E, et al. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently[J]. Anesth Analg, 2004, 98(4):1172-1177.
21. Alhashemi JA, Kaki AM. Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate[J]. Br J Anaesth, 2003, 91(4):536-540.
22. Frikha N, Ellachtar M, Mebazaa MS, et al. Combined spinal-epidural analgesia in labor-comparison of sufentanil vs tramadol[J]. Middle East J Anesthesiol, 2007, 19(1):87-96.
23. Faiz SH, Rahimzadeh P, Sakhaei MA, et al. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries[J]. J Res Med Sci, 2012, 17(10):918-922.
24. Ho KM, Ismail H, Lee KC, et al. Use of intrathecal neostigmine as an adjunct to other spinal medications in perioperative and peripartum analgesia:a meta-analysis[J]. Anaesth Intensive Care, 2005, 33(1):41-53.
25. Bone HG, Van Aken H, Booke M, et al. Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine[J]. Reg Anesth Pain Med, 1999, 24(5):405-410.
26. Van Elstraete AC, Pastureau F, Lebrun T, et al. Neostigmine added to lidocaine axillary plexus block for postoperative analgesia[J]. Eur J Anaesthesiol, 2001, 18(4):257-260.
27. Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy[J]. Br J Anaesth, 2001, 86(1):77-79.
28. Shadangi BK, Garg R, Pandey R, et al. Effects of intrathecal midazolam in spinal anaesthesia:a prospective randomised case control study[J]. Singapore Med J, 2011, 52(6):432-435.
29. Jarbo K, Batra YK, Panda NB. Brachial plexus block with midazolam and bupivacaine improves analgesia[J]. Can J Anaesth, 2005, 52(8):822-826.
30. Choudhuri AH, Dharmani P, Kumarl N, et al. Comparison of caudal epidural bupivacaine with bupivacaine plus tramadol and bupivacaine plus ketamine for postoperative analgesia in children[J]. Anaesth Intensive Care, 2008, 36(2):174-179.
31. Elia N, Tramèr MR. Ketamine and postoperative pain:a quantitative systematic review of randomised trials[J]. Pain, 2005, 113(1/2):61-70.
32. 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(7):821-826.
33. Berde CB, Athiraman U, Yahalom BA, et al. Tetrodotoxin-bupivacaine-epinephrine combinations for prolonged local anesthesia[J]. Mar Drugs, 2011, 9(12):2717-2728.
34. Binshtok AM, Bean BP, Woolf CJ. Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers[J]. Nature, 2007, 449(7162):U13-607.
35. Ries CR, Pillai R, Chung CC, et al. QX-314 produces long-lasting local anesthesia modulated by transient receptor potential vanilloid receptors in mice[J]. Anesthesiology, 2009, 111(1):122-126.
36. Shen J, Fox LE, Cheng J. Differential effects of peripheral versus central coadministration of QX-314 and capsaicin on neuropathic pain in rats[J]. Anesthesiology, 2012, 117(2):365-380.
37. Wang CF, Gerner P, Schmidt B, et al. Use of bulleyaconitine A as an adjuvant for prolonged cutaneous analgesia in the rat[J]. Anesth Analg, 2008, 107(4):1397-1405.

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