Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada.
Anaesthesia. 2020 Jan;75 Suppl 1:e101-e110. doi: 10.1111/anae.14868.
Regional anaesthesia has undergone several exciting advances in the past few decades. Ultrasound-guided techniques of peripheral nerve blockade have become the gold standard thanks to the associated improvements in efficacy, ease of performance and safety. This has increased the accessibility and utilisation of regional anaesthesia in the anaesthesia community at large and is timely given the mounting evidence for its potential benefits on various patient-centred outcomes, including major morbidity, cancer recurrence and persistent postoperative pain. Ultrasound guidance has also paved the way for refinement of the technical performance of existing blocks concerning simplicity and safety, as well as the development of new regional anaesthesia techniques. In particular, the emergence of fascial plane blocks has further broadened the application of regional anaesthesia in the management of painful conditions of the thorax and abdomen. The preliminary results of investigations into these fascial plane blocks are promising but require further research to establish their true value and role in clinical care. One of the challenges that remains is how best to prolong regional anaesthesia to maximise its benefits while avoiding undue harm. There is ongoing research into optimising continuous catheter techniques and their management, intravenous and perineural pharmacological adjuncts, and sustained-release local anaesthetic molecules. Finally, there is a growing appreciation for the critical role that regional anaesthesia can play in an overall multimodal anaesthetic strategy. This is especially pertinent given the current focus on eliminating unnecessary peri-operative opioid administration.
在过去的几十年中，区域麻醉学取得了多项令人兴奋的进展。由于外周神经阻滞的超声引导技术在疗效、操作简便性和安全性方面的改进，它已成为金标准。这增加了区域麻醉在整个麻醉界的可及性和使用率，并且鉴于其在各种以患者为中心的结局（包括主要发病率、癌症复发和持续术后疼痛）方面的潜在益处的证据越来越多，这一时间点恰到好处。超声引导还为现有技术的技术性能的改进铺平了道路，包括提高简单性和安全性，以及开发新的区域麻醉技术。特别是，筋膜平面阻滞的出现进一步扩大了区域麻醉在治疗胸部和腹部疼痛疾病方面的应用。这些筋膜平面阻滞的初步研究结果很有希望，但需要进一步的研究来确定它们在临床护理中的真正价值和作用。仍然存在的挑战之一是如何最好地延长区域麻醉时间，以最大程度地发挥其益处，同时避免不必要的伤害。目前正在研究优化连续导管技术及其管理、静脉和周围神经药理学辅助剂以及持续释放局部麻醉剂分子。最后，人们越来越认识到区域麻醉在整体多模式麻醉策略中可以发挥的关键作用。鉴于目前关注消除围手术期不必要的阿片类药物使用，这一点尤其重要。
