Marrone Francesco, Fusco Pierfrancesco, Pilia Eros, Colantonio Laura B, Pullano Carmine
Unit of Anesthesia and Intensive Care, Santo Spirito Hospital, Rome, Italy -
Unit of Anesthesia and Intensive Care, SS Filippo and Nicola Hospital, Avezzano, L'Aquila, Italy.
Minerva Anestesiol. 2025 Apr;91(4):325-333. doi: 10.23736/S0375-9393.24.18476-3. Epub 2024 Dec 10.
The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. The aim of this up-to-date review was to provide the newest insights on the two adjuvants dexamethasone and dexmedetomidine for regional anesthesia. The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.
局部麻醉药作用机制的发现，涉及钠离子通道的阻断，被认为是麻醉领域的一个里程碑。在血管内注射局部麻醉药（LA）或因全身重吸收导致剂量超限时，可能会出现潜在的致命毒性作用。人们通过研发新型局部麻醉药和添加佐剂来试图预防这些危及生命的事件。这篇最新综述的目的是提供关于地塞米松和右美托咪定这两种用于区域麻醉的佐剂的最新见解。与单独使用神经周围佐剂相比，神经周围添加地塞米松 - 右美托咪定组合已显示出区域麻醉起效更快、作用持续时间更长以及神经阻滞强度增加。这与局部麻醉效果显著延长的临床研究（试验、观察性研究和报告）一致。然而，需要进一步研究以确定该技术的全部潜力以及所有可能的相关风险。
