Department of Anesthesiology, Unidade Local de Saúde São João.
UnIC@RISE.
Curr Opin Anaesthesiol. 2024 Oct 1;37(5):520-525. doi: 10.1097/ACO.0000000000001398. Epub 2024 Jun 12.
Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations.
Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered.
Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.
局部麻醉药的药代动力学是区域麻醉成功和安全的主要决定因素之一，包括局部和全身分布阶段。本文旨在结合不同手术和患者人群进行的各种区域阻滞，总结该主题的最新研究结果。
局部麻醉药的局部动力学和全身吸收的研究主要集中在新型筋膜平面阻滞上，特别是竖脊肌平面阻滞，因为这些阻滞在区域麻醉和疼痛管理中越来越被采用。由于其临床疗效非常依赖于大剂量局部麻醉药的注射，因此通常给予超过典型推荐剂量的药物。
筋膜平面阻滞是最需要药代动力学特征描述的区域阻滞技术，不仅要更好地了解其复杂的作用机制，还要避免因局部麻醉药过量而造成的伤害。进一步确定不同阻滞部位给药时发生全身毒性的危险因素至关重要。年龄极端和妊娠是脆弱的患者群体，但在这些患者群体中，包括新型技术在内的区域麻醉已很少发生并发症。
