Zink W, Steinfeldt T, Wiesmann T
Klinik für Anästhesiologie, Operative Intensivmedizin und Notfallmedizin, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr 79, 67063, Ludwigshafen, Deutschland.
Klinik für Anästhesiologie und operative Intensivmedizin, Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Deutschland.
Anaesthesist. 2020 May;69(5):301-313. doi: 10.1007/s00101-020-00740-7.
For decades local anesthetics have proven to be safe and effective drugs in the clinical practice, crucially promoting the enormous achievements in regional anesthesia. Meanwhile, it is a well-known fact that local anesthetics are much more than just "simple" sodium channel blockers. They also interact with numerous other ion channels and subcellular structures, enhancing nerve blockade and resulting in systemic "alternative" effects, which can sometimes even be clinically used. By the simultaneous administration of various adjuvants (e.g., opioids, corticosteroids and α-receptor agonists) attempts are made to prolong the time of action of local anesthetics after a single administration in order to achieve the best possible improvement in postoperative analgesia. In this context, ultralong-acting local anesthetics, such as liposomal bupivacaine, which at least theoretically can provide a sensory nerve block for several days, have been developed and clinically introduced. The coming years will show whether these approaches will develop into genuine alternatives to the personnel and cost-intensive continuous nerve blockades.Local anesthetic-induced systemic toxicity is meanwhile rare but still a potentially life-threatening event, frequently resulting from accidental intravascular injection or extensive systemic resorption. Consequently, slow and fractional application of these agents with intermittent aspiration helps to prevent toxic sequelae. If toxic symptoms occur, however, the intravenous infusion of 20% lipid solutions in addition to basic treatment measures can enhance the success of treatment.
几十年来，局部麻醉药在临床实践中已被证明是安全有效的药物，对区域麻醉的巨大成就起到了关键的推动作用。与此同时，众所周知，局部麻醉药远不止是“简单的”钠通道阻滞剂。它们还与许多其他离子通道和亚细胞结构相互作用，增强神经阻滞并产生全身“替代”效应，有时甚至可用于临床。通过同时给予各种佐剂（如阿片类药物、皮质类固醇和α受体激动剂），人们试图延长局部麻醉药单次给药后的作用时间，以尽可能地改善术后镇痛效果。在此背景下，已经研发出并临床应用了超长效局部麻醉药，如脂质体布比卡因，至少从理论上讲，它可以提供数天的感觉神经阻滞。未来几年将表明这些方法是否会发展成为人员和成本密集型连续神经阻滞的真正替代方法。局部麻醉药引起的全身毒性虽然罕见，但仍然是一个潜在的危及生命的事件，通常是由意外血管内注射或广泛的全身吸收引起的。因此，缓慢分次应用这些药物并间歇性回抽有助于预防毒性后遗症。然而，如果出现中毒症状，除了基本治疗措施外，静脉输注20%脂质溶液可提高治疗成功率。
