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首页> 外文期刊>Current opinion in anaesthesiology >Practical use of local anesthetics in regional anesthesia
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Practical use of local anesthetics in regional anesthesia

机译：局麻药在局部麻醉中的实际应用

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Purpose of Review: The choice of local anesthetics in regional anesthesia depends on desired onset, intensity, and duration of block, as well as possible adverse effects. This review highlights recent advances in day-case spinal anesthesia; considerations in selecting local anesthetic volume, concentration, and mass in peripheral nerve blockade; and the pharmacokinetics of ropivacaine. Recent Findings: Spinal anesthesia using 2-chloroprocaine offers fast onset and rapid recovery, whereas mepivacaine and lidocaine are suitable for longer procedures. Intrathecal lidocaine in the lithotomy position carries a significant risk of transient neurologic symptoms and should be avoided. Dosing studies of local anesthetics in peripheral nerve blockade suggest that mass of drug, not volume or concentration, primarily determines block onset, success, and duration. Commonly used doses of ropivacaine for Transversus Abdominis Plane blocks can result in high plasma concentrations and local anesthetic systemic toxicity. Summary: There are effective alternatives to bupivacaine in day-case spinal anesthesia but more safety and outcome data are required, particularly for 2-chloroprocaine. The trend toward smaller doses of local anesthetics in ultrasound-guided regional anesthesia improves safety but should be weighed against possible reductions in speed of onset and analgesic duration. Strategies to reduce the risk of local anesthetic systemic toxicity should be employed when performing large-volume fascial plane blocks with ropivacaine.
机译：审查目的：在区域麻醉中选择局部麻醉药取决于所需的起效，强度和阻塞持续时间，以及可能的不良反应。这篇综述重点介绍了日间脊柱麻醉的最新进展;选择周围麻醉神经阻滞剂的局部麻醉剂量，浓度和质量的注意事项;和罗哌卡因的药代动力学。最新发现：使用2-氯普鲁卡因进行的脊髓麻醉具有起效快，恢复快的优点，而米比卡因和利多卡因适用于更长的手术时间。截石位鞘内注射利多卡因具有暂时性神经系统症状的重大风险，应避免。周围神经阻滞中局部麻醉药的剂量研究表明，药物的质量而不是体积或浓度主要决定了阻滞的发作，成功和持续时间。罗非卡因用于腹横肌阻滞剂的常用剂量可导致高血浆浓度和局部麻醉剂全身毒性。摘要：在日间脊柱麻醉中，存在布比卡因的有效替代品，但需要更多的安全性和结果数据，尤其是2-氯普鲁卡因。在超声引导的区域麻醉中使用局部麻醉药剂量较小的趋势可提高安全性，但应权衡其可能会降低起效速度和止痛持续时间。当使用罗哌卡因进行大剂量筋膜平面阻滞时，应采取降低局部麻醉剂全身毒性风险的策略。

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