王牧野;谭晶;张瑜;崔晓光;

• 1:哈尔滨医科大学附属第二医院麻醉科

摘要(Abstract)：

局部麻醉药能够阻断神经冲动的发生与传递,可逆性地引起感觉缺失,从而产生麻醉效果。然而,以往局部麻醉药物作用时间较短,术后镇痛效果不佳,限制了局麻药物的应用。随着近年来医疗行业的飞速发展以及众多药物的不断出现,临床上多以局麻药物与辅助药物联合应用的方式,获得更为良好的镇痛效果的同时减少了药物的用量。多项研究表明,右美托咪定作为一种高选择性的α_2肾上腺受体激动剂,以不同的方式与局麻药配伍应用后,可不同程度地影响其起效时间、作用时效、作用效果等。本文主要就右美托咪定与局麻药物联合应用的进展进行综述。

关键词(KeyWords)： 右美托咪定;局麻药;镇痛

Abstract:

Keywords:

基金项目(Foundation): 黑龙江省自然科学基金(QC2015125);; 哈尔滨医科大学附属第二医院科研创新基金(KYBS201505)

作者(Author): 王牧野;谭晶;张瑜;崔晓光;

Email:

DOI: 10.14053/j.cnki.ppcr.201905023

参考文献(References)：

• [1] Olutoye OA,Glover CD,Diefenderfer JW,et al.The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy[J].Anesth Analg,2010,111(2):490-495.
• [2] Tan JA,Ho KM.Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients:a meta-analysis[J].Intensive Care Med,2010,36(6):926-939.
• [3] Paul S,Bhattacharjee DP,Ghosh S,et al.Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery[J].Ceylon Med J,2010,55(4):111-115.
• [4] Correa-Sales C,Rabin BC,Maze M.A hypnotic response to dexmedetomidine,an alpha 2 agonist,is mediated in the locus coeruleus in rats[J].Anesthesiology,1992,76(6):948-952.
• [5] Khan ZP,Ferguson CN,Jones RM.Alpha-2 and imidazoline receptor agonists:their pharmacology and therapeutic role[J].Anaesthesia,1999,54(2):146-165.
• [6] Zheng Y,Cui S,Liu Y,et al.Dexmedetomidine prevents remifentanil-induced postoperative hyperalgesia and decreases spinal tyrosine phosphorylation of N-methyl-d-aspartate receptor 2B subunit[J].Brain Res Bull,2012,87(4-5):427-431.
• [7] Dederer H,Berger M,Meyer T,et al.Structure-activity relationships of acetylcholine derivatives with Lucilia cuprina nicotinic acetylcholine receptor α1 and α2 subunits in chicken β2 subunit hybrid receptors in comparison with chicken nicotinic acetylcholine receptor α4/β2[J].Insect Mol Biol,2013,22(2):183-198.
• [8] Giovannitti JA,Rosenberg MB,Phero JC.Pharmacology of local anesthetics used in oral surgery[J].Oral Maxillofac Surg Clin North Am,2013,25(3):453-465,vi.
• [9] Lili X,Jianjun S,Haiyan Z.The application of dexmedetomidine in children undergoing vitreoretinal surgery[J].J Anesth,2012,26(4):556-561.
• [10] 刘春芳,姜虹.右旋美托咪啶对切口痛大鼠脊髓背角神经元型一氧化氮合酶和P物质mRNA表达的影响[J].上海医学,2009,32(6):483-486.
• [11] 张亮.右美托咪啶用药安全性的研究进展[J].重庆医学,2013,42(9):1066-1069.
• [12] Arain SR,Ruehlow RM,Uhrich TD,et al.The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery[J].Anesth Analg,2004,98(1):153-158.
• [13] Eisenach JC,De Kock M,Klimscha W.Alpha(2)-adrenergic agonists for regional anesthesia:a clinical review of clonidine (1984-1995)[J].Anesthesiology,1996,85(3):655-674.
• [14] Smith MS,Schambra UB,Wilson KH,et al.Alpha 2-adrenergic receptors in human spinal cord:specific localized expression of mRNA encoding alpha 2-adrenergic receptor subtypes at four distinct levels[J].Brain Res Mol Brain Res,1995,34(1):109-117.
• [15] Mohamed SA,Fares KM,Mohamed AA,et al.Dexmedetomidine as an adjunctive analgesic with bupivacaine in paravertebral analgesia for breast cancer surgery[J].Pain Physician,2014,17(5):E589-E598.
• [16] Tamsen A,Gordh T.Epidural clonidine produces analgesia[J].Lancet,1984,2(8396):223-231.
• [17] Lin YN,Li Q,Yang RM,et al.Addition of dexmedetomidine to ropivacaine improves cervical plexus block[J].Acta Anaesthesiol Taiwan,2013,51(2):63-66.
• [18] Mirkheshti A,Saadatniaki A,Salimi A,et al.Effects of dexmedetomidine versus ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block[J].Anesth Pain Med,2014,4(3):e17620.
• [19] Huang XZ,Tu WF,Peng J,et al.Effect of pre-emptive local injection of ropivocaine with dexmedetomidine on mirror pain in rats and its mechanism[J].Asian Pac J Trop Med,2015,8(10):836-840.
• [20] Li SS,Zhang WS,Ji D,et al.Involvement of spinal microglia and interleukin-18 in the anti-nociceptive effect of dexmedetomidine in rats subjected to CCI[J].Neurosci Lett,2014,560(7):21-25.
• [21] Degos V,Charpentier TL,Chhor V,et al.Neuroprotective effects of dexmedetomidine against glutamate agonist-induced neuronal cell death are related to increased astrocyte brain-derived neurotrophic factor expression[J].Anesthesiology,2013,118(5):1123-1132.
• [22] Usta B,Gozdemir M,Demircioglu RI,et al.Dexmedetomidine for the prevention of shivering during spinal anesthesia[J].Clinics (Sao Paulo),2011,66(7):1187-1191.
• [23] Doufas AG,Lin CM,Suleman MI,et al.Dexmedetomidine and meperidine additively reduce the shivering threshold in humans[J].Stroke,2003,34(5):1218-1223.
• [24] Gaszyński T.Local anaesthesia for ′awake intubation′ using the TruView PCD video laryngoscope[J].Anaesthesiol Intensive Ther,2014,46(3):210-211.
• [25] Esmaoglu A,Yegenoglu F,Akin A,et al.Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block[J].Anesth Analg,2010,111(6):1548-1551.
• [26] Wu HH,Wang HT,Jin JJ,et al.Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia?A systematic review and meta-analysis[J].PLoS One,2014,9(3):e93114.
• [27] Ali EM,Polat A,Yucel A,et al.Effects of perineural administration of dexmedetomidine in combination with levobupivacaine in a rat sciatic nerve block[J].Curr Ther Res Clin Exp,2013,74:74-78.
• [28] Marhofer D,Kettner SC,Marhofer P,et al.Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J].Br J Anaesth,2013,110(3):438-442.
• [29] Saritas A,Sabuncu C.Comparison of clinical effects of prilocaine,dexamethasone added to prilocaine and levobupivacaine on brachial plexus block[J].J Pak Med Assoc,2014,64(4):433-436.
• [30] Lonnqvist PA.Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children-is there a mechanism of action and should we use them[J].Paediatr Anaesth,2012,22(5):421-424.
• [31] McAlvin JB,Zhan C,Dohlman JC,et al.Corneal anesthesia with site 1 sodium channel blockers and dexmedetomidine[J].Invest Ophthalmol Vis Sci,2015,56(6):3820-3826.
• [32] Lee Y,Kim J,Kim S,et al.Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment[J].J Dent Anesth Pain Med,2016,16(1):25-29.
• [33] Ismail EA,Sayed JA,Bakri MH,et al.Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy:a randomized clinical trial[J].Korean J Pain,2017,30(2):134-141.
• [34] Sun S,Wang J,Bao N,et al.Comparison of dexmedetomidine and fentanyl as local anesthetic adjuvants in spinal anesthesia:a systematic review and meta-analysis of randomized controlled trials[J].Drug Des Devel Ther,2017,11:3413-3424.
• [35] Swami SS,Keniya VM,Ladi SD,et al.Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block:a randomised double-blind prospective study[J].Indian J Anaesth,2012,56(3):243-249.
• [36] Zhang H,Li M,Zhang SY,et al.Intravenous dexmedetomidine promotes spinal bupivacaine anesthesia and postoperative analgesia in lower limb surgery:a double-blind,randomized clinical CONSORT study[J].Medicine (Baltimore),2016,95(8):e2880.
• [37] Hammer GB,Drover DR,Cao H,et al.The effects of dexmedetomidine on cardiac electrophysiology in children[J].Anesth Analg,2008,106(1):79-83.
• [38] Agarwal S,Aggarwal R,Gupta P.Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block[J].J Anaesthesiol Clin Pharmacol,2014,30(1):36-40.
• [39] Konakci S,Adanir T,Yilmaz G,et al.The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route[J].Eur J Anaesthesiol,2008,25(5):403-409.