Krishna Prasad G V, Khanna Sangeeta, Jaishree Sharma Vipin
Department of Anaesthesiology, Military Hospital, Kirkee, Range Hills, Pune, Maharashtra, India.
Saudi J Anaesth. 2020 Jan-Mar;14(1):77-84. doi: 10.4103/sja.SJA_423_19. Epub 2020 Jan 6.
In recent anesthetic practice, peripheral nerve blocks (PNBs) are used extensively for surgical anesthesia and nonsurgical analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients, and in some specific clinical setting, that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. The technique involves the injection of the anesthetic in the vicinity of a specific nerve or bundle of nerves to block the sensation of pain transmitting to a specific portion of the body. However, the length of analgesia when a single anesthetic is used for PNB may not last long. Therefore, the practice of adding an additional agent called adjuvant has been evolved to prolong the analgesic effect. There are many such adjuvants available that are clinically being used for this purpose imparting great efficacy and safety to the anesthetic process. The adjuvants molecules are generally classified as opioids, alpha-2 agonist, steroids, etc. Most of them are safe to use and show little or no adverse event related to neurotoxicity and tissue damage. Although there is extensive use of such adjuvants in the clinical field, none of the molecules is approved by the FDA and is used as an off-label drug. The risk to benefit ratio must be assessed while using such an agent. This review will try to delineate the basic need of adjuvant in peripheral nerve block and will discuss the advantages and limitations of using different adjuvants and will discuss the future prospect of such application.
在最近的麻醉实践中，外周神经阻滞（PNB）被广泛用于手术麻醉和非手术镇痛。在特定患者群体以及某些特定临床环境中，PNB相较于其他麻醉技术具有诸多优势，这可能有助于更快、更安全地缓解疼痛，提高患者满意度，缩短住院时间，并降低总体医疗成本。该技术是将麻醉剂注射到特定神经或神经束附近，以阻断疼痛向身体特定部位的传导。然而，当单一麻醉剂用于PNB时，镇痛时间可能不会持续很长。因此，添加一种名为佐剂的额外药物的做法应运而生，以延长镇痛效果。有许多此类佐剂在临床上用于此目的，为麻醉过程带来了显著的疗效和安全性。佐剂分子通常分为阿片类药物、α-2激动剂、类固醇等。它们大多使用安全，很少或几乎没有与神经毒性和组织损伤相关的不良事件。尽管此类佐剂在临床领域广泛使用，但没有一种分子获得美国食品药品监督管理局（FDA）的批准，属于超说明书用药。使用此类药物时必须评估风险效益比。本综述将试图阐述外周神经阻滞中使用佐剂的基本需求，并讨论使用不同佐剂的优缺点，以及此类应用的未来前景。
