is an assistant professor of nursing, Program of Nurse Anesthesiology, University of South Florida, Tampa, Florida; adjunct assistant professor of nursing, Program of Nurse Anesthesia, Samuel Merritt University, Oakland, California. Email:
Department of Anesthesiology, University of California Davis, Davis California. E-mail:
AANA J. 2021 Dec;89(6):529-537.
Enhanced Recovery After Surgery (ERAS) protocols have been implemented in many institutions to attenuate the stress of surgery and facilitate early recovery. Careful selection of multimodal analgesic medication plays an essential role in achieving the goals of ERAS protocols. Clonidine and dexmedetomidine are α-adrenergic receptor (α-AR) agonists that can greatly enhance various ERAS components owing to their unique pharmacologic properties: antinociception, anxiolysis, anti-inflammation, and renal protection. The α-AR agonists exert supraspinal and spinal antinociceptive effects by potentiating descending pain modulatory pathways and inhibiting peripheral C fibers. These antinociceptive effects of α-AR agonists are independent of opioid receptors and result in analgesic synergy with opioid agonists. Several meta-analyses and systematic reviews have reported that α-AR agonists decrease opioid consumption and side effects in adult and pediatric surgical patients. Given the wide distribution of α-ARs in the body, α-AR agonists have been associated with a reduction in anxiety, perioperative stress, inflammation, postoperative nausea and vomiting, shivering, and cognitive dysfunction. This course describes the basic and applied pharmacology of the α-AR agonists and provides emerging evidence to support their utility in acute pain management and ERAS protocols. Perioperative administration of α-AR agonists can enhance pain management, decrease adverse effects, and promote surgical recovery.
加速康复外科（ERAS）方案已在许多机构中实施，以减轻手术应激并促进早期康复。多模式镇痛药物的精心选择在实现 ERAS 方案目标方面起着至关重要的作用。可乐定和右美托咪定是α-肾上腺素能受体（α-AR）激动剂，由于其独特的药理特性，可极大地增强各种 ERAS 成分：镇痛、抗焦虑、抗炎和肾保护。α-AR 激动剂通过增强下行疼痛调节途径和抑制外周 C 纤维发挥脊髓上和脊髓镇痛作用。这些 α-AR 激动剂的镇痛作用不依赖于阿片受体，并与阿片激动剂产生协同作用。几项荟萃分析和系统评价报告称，α-AR 激动剂可减少成年和儿科手术患者的阿片类药物消耗和副作用。鉴于 α-AR 在体内的广泛分布，α-AR 激动剂与焦虑、围手术期应激、炎症、术后恶心和呕吐、寒战和认知功能障碍的减少有关。本课程描述了 α-AR 激动剂的基础和应用药理学，并提供了支持其在急性疼痛管理和 ERAS 方案中的应用的新证据。围手术期给予 α-AR 激动剂可以增强疼痛管理，减少不良反应，并促进手术恢复。
