Buvanendran Asokumar, Kroin Jeffrey S
Department of Anesthesiology, 1653 W Congress Parkway, # 739, Rush University Medical Center, Chicago, IL 60612, USA.
Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):31-49. doi: 10.1016/j.bpa.2006.12.003.
Adjuvants are compounds which by themselves have undesirable side-effects or low potency but in combination with opioids allow a reduction of narcotic dosing for postoperative pain control. Adjuvants are needed for postoperative pain management due to side-effects of opioid analgesics, which hinder recovery, especially in the increasingly utilized ambulatory surgical procedures. NMDA antagonists have psychomimetic side-effects at high doses, but at moderate doses do not cause stereotypic behavior but allow reduction in opioid dose to obtain better pain control. Alpha-2 adrenergic agonists cause sedation, hypotension and bradycardia at moderate doses, but at low doses can be opioid sparing especially in spinal administration. Gabapentin-like compounds have low potency against acute pain, but in combination with opioids allow a reduction in opioid dose with improved analgesia. Corticosteroids may have only a limited role as adjuvants while acetylcholine esterase inhibitors may have too many side-effects. Newer adjuvants will be needed to reduce opioid dose and concomitant side-effects, even more as same day surgeries become more routine.
辅助药物是自身具有不良副作用或效力较低，但与阿片类药物联合使用可减少用于术后疼痛控制的麻醉药物剂量的化合物。由于阿片类镇痛药的副作用会阻碍恢复，尤其是在越来越多地采用的门诊手术中，因此术后疼痛管理需要辅助药物。NMDA拮抗剂在高剂量时有拟精神病副作用，但在中等剂量时不会引起刻板行为，反而能减少阿片类药物剂量以获得更好的疼痛控制。α-2肾上腺素能激动剂在中等剂量时会引起镇静、低血压和心动过缓，但在低剂量时尤其是脊髓给药时可节省阿片类药物。加巴喷丁样化合物对急性疼痛的效力较低，但与阿片类药物联合使用可减少阿片类药物剂量并改善镇痛效果。皮质类固醇作为辅助药物的作用可能有限，而乙酰胆碱酯酶抑制剂可能有太多副作用。随着同日手术变得更加常规，将需要更新的辅助药物来减少阿片类药物剂量和随之而来的副作用。
