Verlinde Mark, Hollmann Markus W, Stevens Markus F, Hermanns Henning, Werdehausen Robert, Lirk Philipp
Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, The Netherlands.
Department of Anesthesiology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany.
Int J Mol Sci. 2016 Mar 4;17(3):339. doi: 10.3390/ijms17030339.
This review summarizes current knowledge concerning incidence, risk factors, and mechanisms of perioperative nerve injury, with focus on local anesthetic-induced neurotoxicity. Perioperative nerve injury is a complex phenomenon and can be caused by a number of clinical factors. Anesthetic risk factors for perioperative nerve injury include regional block technique, patient risk factors, and local anesthetic-induced neurotoxicity. Surgery can lead to nerve damage by use of tourniquets or by direct mechanical stress on nerves, such as traction, transection, compression, contusion, ischemia, and stretching. Current literature suggests that the majority of perioperative nerve injuries are unrelated to regional anesthesia. Besides the blockade of sodium channels which is responsible for the anesthetic effect, systemic local anesthetics can have a positive influence on the inflammatory response and the hemostatic system in the perioperative period. However, next to these beneficial effects, local anesthetics exhibit time and dose-dependent toxicity to a variety of tissues, including nerves. There is equivocal experimental evidence that the toxicity varies among local anesthetics. Even though the precise order of events during local anesthetic-induced neurotoxicity is not clear, possible cellular mechanisms have been identified. These include the intrinsic caspase-pathway, PI3K-pathway, and MAPK-pathways. Further research will need to determine whether these pathways are non-specifically activated by local anesthetics, or whether there is a single common precipitating factor.
本综述总结了有关围手术期神经损伤的发生率、危险因素和机制的现有知识，重点关注局部麻醉药引起的神经毒性。围手术期神经损伤是一种复杂的现象，可由多种临床因素引起。围手术期神经损伤的麻醉危险因素包括区域阻滞技术、患者危险因素以及局部麻醉药引起的神经毒性。手术可通过使用止血带或对神经施加直接机械应力（如牵引、横断、压迫、挫伤、缺血和拉伸）导致神经损伤。当前文献表明，大多数围手术期神经损伤与区域麻醉无关。除了负责麻醉作用的钠通道阻滞外，全身局部麻醉药可在围手术期对炎症反应和止血系统产生积极影响。然而，除了这些有益作用外，局部麻醉药对包括神经在内的多种组织表现出时间和剂量依赖性毒性。有模棱两可的实验证据表明，不同局部麻醉药的毒性有所不同。尽管局部麻醉药引起神经毒性的确切事件顺序尚不清楚，但已确定了可能的细胞机制。这些机制包括内在的半胱天冬酶途径、PI3K途径和MAPK途径。进一步的研究需要确定这些途径是被局部麻醉药非特异性激活，还是存在单一的共同促发因素。
