본문 바로가기
KERD
논문KCI 등재

신경차단 시 국소마취제와 함께 사용되는 보조 약물들

Adjuvant medications to local anesthetics in nerve blockade

이덕희
영남대학교 의과대학 (Yeungnam University College of Medicine)|2017.12|Journal of Yeungnam Medical Science|제34권 제2호|pp. 161-168

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

Local anestheticsAdjuvantsNerve block
주제분류의학일반

초록

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, singleinjection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness

Abstract

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, singleinjection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness

참고문헌 (66)

  1. Scott DB, "Acute toxicity of ropivacaine compared with that of bupivacaine", Anesth Analg, 69, pp.563~569 (1989)
  2. Förster JG, "Clinically useful adjuvants in regional anaesthesia", Curr Opin Anaesthesiol, 16, pp.477~486 (2003)
  3. Murphy DB, "Novel analgesic adjuncts for brachial plexus block: a systematic review", Anesth Analg, 90, pp.1122~1128 (2000)
  4. Ivani G, "Ropivacaine-clonidine combination for caudal blockade in children", Acta Anaesthesiol Scand, 44, pp.446~449 (2000)
  5. Bernards CM, "Effect of epinephrine on central nervous system and cardiovascular system toxicity of bupivacaine in pigs", Anesthesiology, 71, pp.711~717 (1989)
  6. Gaumann D, "Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block", Anesth Analg, 75, pp.69~74 (1992)
  7. Hickey R, "Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block", Can J Anaesth, 37, pp.878~882 (1990)
  8. Bernards CM, "Effect of epinephrine on lidocaine clearance in vivo: a microdialysis study in humans", Anesthesiology, 91, pp.962~968 (1999)
  9. Weber A, "Epinephrine does not prolong the analgesia of 20mL ropivacaine 0.5% or 0.2% in a femoral three-in-one block", Anesth Analg, 93, pp.1327~1331 (2001)
  10. Karm MH, "Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: a multicenter, randomized, double-blind, crossover, phase IV trial", Medicine (Baltimore), 96, pp.e6753~ (2017)
  11. Sinnott CJ, "On the mechanism by which epinephrine potentiates lidocaine’s peripheral nerve block", Anesthesiology, 98, pp.181~188 (2003)
  12. Tetzlaff JE, "Alkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery", Reg Anesth, 15, pp.242~244 (1990)
  13. Yung E, "Bicarbonate plus epinephrine shortens the onset and prolongs the duration of sciatic block using chloroprocaine followed by bupivacaine in sprague-dawley rats", Reg Anesth Pain Med, 34, pp.196~200 (2009)
  14. Capogna G, "Alkalinization of local anesthetics. Which block, which local anesthetic?", Reg Anesth, 20, pp.369~377 (1995)
  15. Tandoc MN, "Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial", J Anesth, 25, pp.704~709 (2011)
  16. Sherif AA, "Dexamethasone as adjuvant for femoral nerve block following knee arthroplasty: a randomized, controlled study", Acta Anaesthesiol Scand, 60, pp.977~987 (2016)
  17. Jæger P, "Does dexamethasone have a perineural mechanism of action? A paired, blinded, randomized, controlled study in healthy volunteers", Br J Anaesth, 117, pp.635~641 (2016)
  18. Attardi B, "Glucocorticoid induced up-regulation of a pituitary K+ channel mRNA in vitro and in vivo", Receptors Channels, 1, pp.287~293 (1993)
  19. Stein C, "The control of pain in peripheral tissue by opioids", N Engl J Med, 332, pp.1685~1690 (1995)
  20. Bourke DL, "Improved postoperative analgesia with morphine added to axillary block solution", J Clin Anesth, 5, pp.114~117 (1993)
  21. Picard PR, "Analgesic efficacy of peripheral opioids (all except intra-articular): a qualitative systematic review of randomised controlled trials", Pain, 72, pp.309~318 (1997)
  22. Candido KD, "Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients", Reg Anesth Pain Med, 26, pp.352~356 (2001)
  23. Candido KD, "Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving infragluteal sciatic nerve block", Anesthesiology, 113, pp.1419~1426 (2010)
  24. Leffler A, "Local anesthetic-like inhibition of voltagegated Na(+) channels by the partial μ-opioid receptor agonist buprenorphine", Anesthesiology, 116, pp.1335~1346 (2012)
  25. Movafegh A, "An ultra-low dose of naloxone added to lidocaine or lidocainefentanyl mixture prolongs axillary brachial plexus blockade", Anesth Analg, 109, pp.1679~1683 (2009)
  26. Marashi SM, "Naloxone added to bupivacaine or bupivacaine-fentanyl prolongs motor and sensory block during supraclavicular brachial plexus blockade: a randomized clinical trial", Acta Anaesthesiol Scand, 59, pp.921~927 (2015)
  27. Haeseler G, "Tramadol, fentanyl and sufentanil but not morphine block voltage-operated sodium channels", Pain, 126, pp.234~244 (2006)
  28. Mert T, "Differential effects of lidocaine and tramadol on modified nerve impulse by 4-aminopyridine in rats", Pharmacology, 69, pp.68~73 (2003)
  29. Kapral S, "Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade", Anesth Analg, 88, pp.853~856 (1999)
  30. Kaabachi O, "Tramadol as an adjuvant to lidocaine for axillary brachial plexus block", Anesth Analg, 108, pp.367~370 (2009)
  31. Mannion S, "Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study", Br J Anaesth, 94, pp.352~356 (2005)
  32. Alemanno F, "Buprenorphine versus tramadol as perineural adjuvants for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair under middle interscalene block: a retrospective study", Minerva Anestesiol, 80, pp.1198~1204 (2014)
  33. Gillberg PG, "Behavioral effects after intrathecal administration of cholinergic receptor agonists in the rat", Psychopharmacology, 100, pp.464~469 (1990)
  34. Krukowski JA, "Intrathecal neostigmine for post-cesarean section analgesia:dose response", Anesth Analg, 84, pp.1269~1275 (1997)
  35. Bouaziz H, "No enhancement of sensory and motor blockade by neostigmine added to mepivacaine axillary plexus block", Anesthesiology, 91, pp.78~83 (1999)
  36. Van Elstraete AC, "Neostigmine added to lidocaine axillary plexus block for postoperative analgesia", Eur J Anaesthesiol, 18, pp.257~260 (2001)
  37. Yang LC, "Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy", Anesthesiology, 88, pp.334~339 (1998)
  38. Nishiyama T, "Midazolam improves postoperative epidural analgesia with continuous infusion of local anaesthetics", Can J Anaesth, 45, pp.551~555 (1998)
  39. Kim MH, "Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy", Br J Anaesth, 86, pp.77~79 (2001)
  40. Jarbo K, "Brachial plexus block with midazolam and bupivacaine improves analgesia", Can J Anaesth, 52, pp.822~826 (2005)
  41. Clerc S, "Is the effect of inguinal field block with 0.5% bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) ketamine?", Clin J Pain, 21, pp.101~105 (2005)
  42. Lee IO, "No enhancement of sensory and motor blockade by ketamine added to ropivacaine interscalene brachial plexus blockade", Acta Anaesthesiol Scand, 46, pp.821~826 (2002)
  43. Koinig H, "Magnesium sulfate reduces intra- and postoperative analgesic requirements", Anesth Analg, 87, pp.206~210 (1998)
  44. Buvanendran A, "Intrathecal magnesium prolongs fentanyl analgesia:a prospective, randomized, controlled trial", Anesth Analg, 95, pp.661~666 (2002)
  45. Arcioni R, "Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce postoperative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery", Acta Anaesthesiol Scand, 51, pp.482~489 (2007)
  46. Lee AR, "Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block", Can J Anaesth, 59, pp.21~27 (2012)
  47. Ekmekci P, "The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction", Knee Surg Sports Traumatol Arthrosc, 21, pp.1119~1124 (2013)
  48. Ammar AS, "Does the addition of magnesium to bupivacaine improve postoperative analgesia of ultrasoundguided thoracic paravertebral block in patients undergoing thoracic surgery?", J Anesth, 28, pp.58~63 (2014)
  49. Elia N, "Clonidine as an adjuvant to intrathecal local anesthetics for surgery:systematic review of randomized trials", Reg Anesth Pain Med, 33, pp.159~167 (2008)
  50. Farmery AD, "The analgesic effect of epidural clonidine after spinal surgery: a randomized placebo-controlled trial", Anesth Analg, 108, pp.631~634 (2009)
  51. Butterworth JF, "The alpha 2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers", Anesth Analg, 76, pp.295~301 (1993)
  52. Bernard JM, "Dose-range effects of clonidine added to lidocaine for brachial plexus block", Anesthesiology, 87, pp.277~284 (1997)
  53. McCartney CJ, "Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature", Reg Anesth Pain Med, 32, pp.330~338 (2007)
  54. Pöpping DM, "Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials", Anesthesiology, 111, pp.406~415 (2009)
  55. YaDeau JT, "Clonidine and analgesic duration after popliteal fossa nerve blockade: randomized, double-blind, placebo-controlled study", Anesth Analg, 106, pp.1916~1920 (2008)
  56. Trifa M, "The addition of clonidine to bupivacaine in saphenous", sciatic nerve blocks in children, 2016, pp.26, 321~322
  57. Madan R, "A dose response study of clonidine with local anesthetic mixture for peribulbar block: a comparison of three doses", Anesth Analg, 93, pp.1593~1597 (2001)
  58. Singelyn FJ, "A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block", Anesth Analg, 83, pp.1046~1050 (1996)
  59. Virtanen R, "Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist", Eur J Pharmacol, 150, pp.9~14 (1988)
  60. Keniya VM, "Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement", Indian J Anaesth, 55, pp.352~357 (2011)
  61. Kanazi GE, "Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block", Acta Anaesthesiol Scand, 50, pp.222~227 (2006)
  62. Brummett CM, "Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat", Anesthesiology, 111, pp.1111~1119 (2009)
  63. Brummett CM, "Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block", Reg Anesth Pain Med, 35, pp.427~431 (2010)
  64. Esmaoglu A, "Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block", Anesth Analg, 111, pp.1548~1551 (2010)
  65. Rancourt MP, "Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine", Anesth Analg, 115, pp.958~962 (2012)
  66. El-Boghdadly K, "Perineural dexmedetomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block:a systematic review and meta-analysis", Anesth Analg, 124, pp.2008~2020 (2017)

이 간행물의 다른 논문 (24건)

Role of the transforming growth factor (TGF)-β1 and TGF-β1 signaling pathway on the pathophysiology of respiratory pneumococcal infections임재향, ANDRADE VALLEJO MAR IA JOSEpp. 149-160크론병에서 복잡성 항문주위 샛길의 수술적 치료김소현pp. 169-173새로운 non-apoptotic 세포사멸: ferroptosis우선민, 권택규pp. 174-181최근 3년간 기저질환이 없는 소아 입원 환자에서 호흡기 바이러스에 따른 급성 하기도 감염의 임상적 특징서민해, 김형영, 김혜영, 엄태민, 박희주pp. 182-190Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment민향기, 유승기, 송치우, 김동신, 송창섭, 김세종, 김영빈, 최재웅, 김성환, 박지영pp. 191-199
원문 보기