Polati E, Finco G, Bartoloni A, Rigo V, Gottin L, Pinaroli A M, Barzoi G
Istituto di Anestesia e Rianimazione, Ospedale Policlinico, Università degli Studi, Verona.
Chir Ital. 1995;47(6):30-6.
Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. All these drugs may be administered in combination between them, realising the so called "balanced spinal analgesia". The aim of this study is to analyse the available methods for the evaluation of pharmacological interactions, the types of interaction among different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of postoperative pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of postoperative pain, because these drug combinations are able to provide a satisfactory pain control at low doses with a reduction of the adverse effects. Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable.
术后疼痛缓解的目的是为患者提供主观舒适感，抑制对手术创伤的神经内分泌和代谢反应，并通过让患者更轻松地呼吸、咳嗽、活动以及开始肠内营养来促进功能恢复。阿片类镇痛药无论给药途径如何，都无法实现所有这些目标。除了脊髓给予阿片类药物外，其他药物，如局部麻醉药、α2激动剂和胆碱能药物，经脊髓途径给药时可能产生抗伤害感受作用。所有这些药物可以相互联合使用，实现所谓的“平衡脊髓镇痛”。本研究的目的是分析评估药物相互作用的现有方法、不同脊髓抗伤害感受药物之间的相互作用类型以及平衡脊髓镇痛在术后疼痛治疗中的作用。对所呈现数据的分析表明，阿片类药物 - 局部麻醉药以及阿片类药物 - α2激动剂之间的脊髓协同作用在术后疼痛治疗中可能有用，因为这些药物组合能够以低剂量提供令人满意的疼痛控制并减少不良反应。此外，阿片类药物 - 局部麻醉药的联合使用在消除术后突发疼痛以及抑制对手术创伤的神经内分泌和代谢反应方面也被证明是有效的。特别是在高危患者中，这与更好的预后相关。最后，即使胆碱能药物与阿片类药物或α2激动剂之间的协同作用已得到证实，但目前不建议在人体中通过脊髓途径将其用于术后疼痛的治疗。
