Edinoff Amber N, Fitz-Gerald Joseph S, Holland Krisha Andrea A, Reed Johnnie G, Murnane Sarah E, Minter Sarah G, Kaye Aaron J, Cornett Elyse M, Imani Farnad, Khademi Seyed-Hossein, Kaye Adam M, Urman Richard D, Kaye Alan D
Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA.
School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA.
Anesth Pain Med. 2021 Jul 5;11(3):e117146. doi: 10.5812/aapm.117146. eCollection 2021 Jun.
The potential for misuse, overdose, and chronic use has led researchers to look for other methods to decrease opioid consumption in patients with acute and chronic pain states. The use of peripheral nerve blocks for surgery has gained increasing popularity as it minimizes peripheral pain signals from the nociceptors of local tissue sustaining trauma and inflammation from surgery. The individualization of peripheral nerve blocks using adjuvant drugs has the potential to improve patient outcomes and reduce chronic pain. The major limitations of peripheral nerve blocks are their limited duration of action and dose-dependent adverse effects. Adjuvant drugs for peripheral nerve blocks show increasing potential as a solution for postoperative and chronic pain with their synergistic effects to increase the duration of action and decrease the required dosage of local anesthetic. N-methyl-d-aspartate (NMDA) receptor antagonists are a viable option for patients with opioid resistance and neuropathic pain due to their affinity to the neurotransmitter glutamate, which is released when patients experience a noxious stimulus. Neostigmine is a cholinesterase inhibitor that exerts its effect by competitively binding at the active site of acetylcholinesterase, which prevents the hydrolysis of acetylcholine and subsequently retaining acetylcholine at the nerve terminal. Epinephrine, also known as adrenaline, can potentially be used as an adjuvant to accelerate and prolong analgesic effects in digital nerve blocks. The theorized role of sodium bicarbonate in local anesthetic preparations is to increase the pH of the anesthetic. The resulting alkaline solution enables the anesthetic to more readily exist in its un-ionized form, which more efficiently crosses lipid membranes of peripheral nerves. However, more research is needed to show the efficacy of these adjuvants for nerve block prolongation as studies have been either mixed or have small sample sizes.
药物滥用、过量使用和长期使用的可能性促使研究人员寻找其他方法来减少急慢性疼痛患者的阿片类药物消费量。外周神经阻滞在手术中的应用越来越普遍，因为它能将局部组织中伤害感受器产生的外周疼痛信号降至最低，这些伤害感受器会因手术创伤和炎症而持续产生疼痛信号。使用辅助药物实现外周神经阻滞个体化，有可能改善患者预后并减轻慢性疼痛。外周神经阻滞的主要局限性在于其作用持续时间有限以及存在剂量依赖性不良反应。外周神经阻滞辅助药物因其具有协同作用，能延长作用时间并减少局部麻醉药所需剂量，在解决术后疼痛和慢性疼痛方面显示出越来越大的潜力。N-甲基-D-天冬氨酸（NMDA）受体拮抗剂是对阿片类药物耐药和患有神经性疼痛患者的一个可行选择，因为它们与神经递质谷氨酸具有亲和力，当患者受到有害刺激时谷氨酸会释放。新斯的明是一种胆碱酯酶抑制剂，它通过在乙酰胆碱酯酶的活性位点竞争性结合发挥作用，从而阻止乙酰胆碱水解，并随后使乙酰胆碱保留在神经末梢。肾上腺素，也被称为 adrenaline，有可能用作辅助药物，以加速和延长指神经阻滞的镇痛效果。理论上，碳酸氢钠在局部麻醉剂制剂中的作用是提高麻醉剂的pH值。由此产生的碱性溶液能使麻醉剂更易以非离子形式存在，从而更有效地穿过外周神经的脂质膜。然而，由于现有研究结果不一或样本量较小，还需要更多研究来证明这些辅助药物在延长神经阻滞方面的疗效。
