Naulty J S
Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037.
Int Anesthesiol Clin. 1990 Winter;28(1):17-24. doi: 10.1097/00004311-199002810-00004.
It appears that complete analgesia for labor using epidural and subarachnoid opiates alone, with a minimum of side effects, remains an unfulfilled goal. However, the combination of extremely small doses of local anesthetics and opiate drugs seems to provide excellent analgesia with a minimum of side effects. This concept of combined opiates and local anesthetics corresponds to that of modern "balanced" general anesthesia, in which small amounts of several drugs are used to provide excellent anesthesia with a minimum of the side effects seen with large doses of any single drug. In my opinion, this "balanced" regional anesthesia holds great promise for the future, especially with the discovery of new drugs that produce spinal analgesia through a variety of mechanisms. These drugs include catecholamines, clonidine, GABA agonists, substance P antagonists, prostaglandin synthetase inhibitors, and many other drugs capable of altering neural transmission in such a way that analgesia results. Obviously, labor analgesia is one area in which these combinations will be explored extensively, and the next few years should be very exciting ones.
单独使用硬膜外和蛛网膜下阿片类药物实现分娩完全镇痛且副作用最小，这似乎仍是一个未达成的目标。然而，极少量局部麻醉药与阿片类药物联合使用似乎能以最小的副作用提供出色的镇痛效果。阿片类药物与局部麻醉药联合使用的这一概念与现代“平衡”全身麻醉的概念相符，即在全身麻醉中使用少量多种药物，以最小的副作用提供出色的麻醉效果，而大剂量使用任何单一药物都会出现较多副作用。在我看来，这种“平衡”区域麻醉未来前景广阔，尤其是随着通过多种机制产生脊髓镇痛作用的新药的发现。这些药物包括儿茶酚胺、可乐定、γ-氨基丁酸（GABA）激动剂、P物质拮抗剂、前列腺素合成酶抑制剂，以及许多其他能够以产生镇痛效果的方式改变神经传递的药物。显然，分娩镇痛是这些联合用药将被广泛探索的领域之一，未来几年将会非常令人期待。
