延长周围神经阻滞时间的研究进展

Research Progress on Prolonging the Duration of Peripheral Nerve Block

摘要: 严重的术后疼痛会使患者感到焦虑紧张、睡眠不足甚至影响术后恢复。全身应用阿片类药物是当前的主要镇痛手段，但其副作用(如恶心、呕吐、便秘和呼吸抑制等)会增加患者的不适，延缓患者的恢复时间。相比之下，区域阻滞技术因其副作用少，镇痛效果显著，逐渐成为围术期疼痛管理的重要方法。然而，目前常用的长效局麻药物如罗哌卡因和布比卡因，单次注射的镇痛时间有限，难以满足术后镇痛的需求。为延长区域阻滞的作用时间，研究者提出了多种策略，包括使用连续外周神经阻滞；添加右美托咪定、地塞米松等佐剂；创新药物输送系统和应用纳米技术等为延长局麻药的镇痛时间提供了新方向。本文综述了这些前沿技术的最新研究进展，以期为临床应用提供参考。

Abstract: Severe postoperative pain can cause anxiety, sleep disturbances, and even affect postoperative recovery. Systemic opioid administration is the primary method for pain relief, but its side effects, such as nausea, vomiting, constipation, and respiratory depression, can increase patient discomfort and delay recovery. In contrast, regional block techniques, due to their fewer side effects and significant analgesic effects, have gradually become an important method for perioperative pain management. However, commonly used long-acting local anesthetics, such as ropivacaine and bupivacaine, have limited analgesic duration with a single injection, making them insufficient to meet the needs for postoperative pain control. To extend the duration of regional block, various strategies have been proposed, including the use of continuous peripheral nerve blocks, the addition of adjuvants such as dexmedetomidine and dexamethasone, innovative drug delivery systems, and the application of nanotechnology. These approaches provide new directions for prolonging the analgesic effects of local anesthetics. This review summarizes the latest research advancements in these cutting-edge technologies to offer guidance for clinical applications.