Williams Brian A
University of Pittsburgh, Pennsylvania 15261, USA.
Int Anesthesiol Clin. 2012 Winter;50(1):126-42. doi: 10.1097/AIA.0b013e31821a00d0.
Although much of the current clinical research is directed toward practitioner-centered refinement of RA techniques and technology, it is important to consider pharmacologic advances in perineural analgesia as the next major patient-centered advancement of our specialty. With all due respect to excellent bench science work with novel drugs and toxins that may not gain approval of the Food and Drug Administration for many years, it is useful to know that four Food and Drug Administration-approved drugs are commercially available for potentially ground-breaking off-label use, pending ongoing research. The extent to which estimated clinical concentrations of clonidine, buprenorphine, and dexamethasone, seem to not influence A-fiber conduction holds significant progress for lower extremity perineural analgesia when weight bearing may be desired, if not at least reducing the risk of falls after these surgeries using typical local anesthetic nerve blocks. Research is also needed to determine the extent to which these four drugs may reduce the needed local anesthetic concentration to achieve a surgical nerve block (on bolus injection). Ongoing research in this direction seems to represent the next major advancement in the subspecialty, being distinguished from refinement research involving strictly techniques and technology.
尽管当前许多临床研究都致力于以从业者为中心优化区域麻醉（RA）技术和工艺，但将神经周围镇痛的药理学进展视为我们专业领域下一个以患者为中心的重大进展是很重要的。尽管对于使用新型药物和毒素进行的出色基础科学研究表示应有的尊重，这些研究可能需要很多年才能获得美国食品药品监督管理局（FDA）的批准，但需要了解的是，有四种FDA批准的药物可用于潜在的突破性非标签用途，相关研究正在进行中。可乐定、丁丙诺啡和地塞米松的估计临床浓度似乎不影响A纤维传导，这对于在可能需要负重的情况下进行下肢神经周围镇痛而言是重大进展，至少在使用典型局部麻醉神经阻滞进行这些手术后可降低跌倒风险。还需要开展研究，以确定这四种药物在多大程度上可以降低实现手术神经阻滞所需的局部麻醉剂浓度（单次注射时）。朝着这个方向正在进行的研究似乎代表了该亚专业领域的下一个重大进展，这与严格涉及技术和工艺的优化研究有所不同。
