Consultant.
Specialist in anesthesia, ICU and pain therapy.
Acta Clin Croat. 2022 Sep;61(Suppl 2):57-66. doi: 10.20471/acc.2022.61.s2.07.
Modern approach in surgical treatment and in managing acute and chronic pain is nowadays more and more based on the implementation of all possible techniques of regional anesthesia (RA). Local anesthetics (LA) are needed to achieve standard regional anesthesia. Local anesthetics are primarily characterized by time constraints and duration of action, and depending on the amount applied, adverse effects on the cardiac and central nervous system may occur. Adjuvants are drugs used together with LA due to their synergistic effect, i.e. they improve start latency and duration of sensory and motor blockade and enable reduction of cumulative dose of LA and reduction of adverse effects on cardiac and nervous system. Nowadays, there is a huge variety of drugs that can be administered in combination with LA, and they, in general, can be divided into opioid and non-opioid adjuvants. The administration of opioids in RA over an extended time period was accompanied by some negative characteristics as respiratory depression, nausea, vomiting. So, their usage is still under a special control. Due to the positive effects shown by drugs from non-opioid adjuvants group (e.g. adrenaline, alpha adrenergic agonists, steroids, magnesium, midazolam, ketamine etc.), indications for their administration broadened. However, there are still some restrains in clinical practice based on the fact that neurotoxicity and demonstration of neurological complications in regional anesthesia haven't been properly researched yet.
如今，在外科治疗和急性及慢性疼痛管理方面，现代方法越来越多地基于实施所有可能的区域麻醉 (RA) 技术。需要局部麻醉剂 (LA) 来实现标准的区域麻醉。局部麻醉剂的主要特征是时间限制和作用持续时间，并且根据应用的剂量，可能会对心脏和中枢神经系统产生不良反应。佐剂是与 LA 一起使用的药物，由于它们具有协同作用，即它们可以改善感觉和运动阻滞的起始潜伏期和持续时间，并能够减少 LA 的累积剂量和减少对心脏和神经系统的不良反应。如今，有各种各样的药物可以与 LA 联合使用，它们通常可以分为阿片类和非阿片类佐剂。在 RA 中长时间给予阿片类药物会伴随一些负面特征，如呼吸抑制、恶心、呕吐。因此，它们的使用仍然受到特殊控制。由于非阿片类佐剂组的药物表现出积极的效果（例如肾上腺素、α 肾上腺素能激动剂、类固醇、镁、咪达唑仑、氯胺酮等），其使用指征扩大了。然而，由于神经毒性和区域麻醉中神经系统并发症的表现尚未得到适当研究，在临床实践中仍存在一些限制。
