手术部位局部浸润麻醉用于术后镇痛的应用进展

Application of local infiltration anesthesia at surgical site in postoperative analgesia

手术部位疼痛是术后患者的主要不良感受,因而围术期无痛化管理成为加速康复外科(ERAS)的重要内容。传统局麻药物由于作用时间有限,尚不能达到单次给药长效镇痛的目的,因此,手术部位局部浸润麻醉的应用受到限制。随着无阿片麻醉(OFA)和少阿片麻醉(ORA)理念的普及以及新型长效局麻药的出现,手术部位局部浸润麻醉在术后镇痛领域逐渐受到重视,其具有止痛效果确切、简单易行、副作用少等优点,可作为围术期镇痛的有效方法。本文围绕手术部位局部浸润麻醉,从作用机制、局麻药辅助用药及给药方法改良、在多模式镇痛中的优劣、新型局麻药的研究进展等方面进行综述,为临床应用提供参考依据。

Surgical site pain is the main adverse sensation for postoperative patients.Therefore,perioperative painless management has become an important aspect of enhanced recovery after surgery(ERAS).Previous local anesthetic drugs are not yet able to meet the purpose of single administration for long-acting analgesia due to their limited duration,so the application of local infiltration anesthesia at surgical site is limited.With the concept of opioid-free anesthesia(OFA)and opioid-reduced anesthesia(ORA)spreading,as well as the appearance of novel local anesthetics,local infiltration anesthesia at surgical site has been paid more and more attention.This method has the advantages of definite analgesia effect,being simple and easy to operate,and few side effects,which can be used as an effective way for perioperative analgesia in clinical practice.This article reviews local infiltration anesthesia at surgical site in terms of the mechanism of local anesthetics,improved local anesthetic adjuvant drugs and methods of administration,advantages and disadvantages in multimodal analgesia,and progression in new local anesthetics,so as to provide a reference for further clinical practice.