地塞米松在局部阻滞中的应用的全面综述和更新。
A Comprehensive Review and Update of the Use of Dexmedetomidine for Regional Blocks.
机构信息
Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.
出版信息
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):121-141.
PURPOSE OF REVIEW
This evidence-based systematic review will focus on the use of dexmedetomidine and its role as adjuvant anesthetics in regional blocks to help better guide physicians in their practice. This review will cover background and mechanism of dexmedetomidine as well as the use in various regional blocks.
RECENT FINDINGS
Local anesthetics are preferred for nerve blocks over opioids; however, both due come with its own side effects. Local anesthetics may be toxic as they disrupt cell membrane and proteins, but by using adjuvants such as dexmedetomidine, that can prolong sensory and motor blocks can reduce total amount of local anesthetics needed. Dexmedetomidine is an alpha-2-adrenergic agonist used as additive for regional nerve block. It has a relatively low side effect profile and have been researched in various regional blocks (intrathecal, paravertebral, axillary, infraclavicular brachial plexus, interscalene). Dexmedetomidine shows promising results as adjuvant anesthetics in most regional blocks.
SUMMARY
Many studies have been done and many show promising results for the use of dexmedetomidine in regional blocks. It may significantly increase in duration of sensory and motor blocks that correlates with lower pain scores and less need of morphine in various regional blocks.
目的综述
本循证系统综述将重点关注右美托咪定的应用及其作为局部麻醉辅助剂在区域阻滞中的作用，以帮助医生更好地指导实践。本综述将涵盖右美托咪定的背景和机制及其在各种区域阻滞中的应用。
最近的发现
与阿片类药物相比，局部麻醉剂更常用于神经阻滞；然而，两者都有其自身的副作用。局部麻醉剂可能有毒，因为它们会破坏细胞膜和蛋白质，但通过使用佐剂（如右美托咪定），可以延长感觉和运动阻滞，减少所需的局部麻醉剂总量。右美托咪定是一种α-2-肾上腺素能激动剂，用作局部神经阻滞的添加剂。它具有相对较低的副作用谱，并已在各种区域阻滞（鞘内、椎旁、腋窝、锁骨下臂丛、肌间沟）中进行了研究。右美托咪定作为辅助麻醉剂在大多数区域阻滞中显示出有前途的结果。
总结
已经进行了许多研究，许多研究表明右美托咪定在区域阻滞中的应用具有前景。它可以显著延长感觉和运动阻滞的持续时间，与各种区域阻滞中较低的疼痛评分和较少的吗啡需求相关。
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