椎管内镇痛药物的应用.pptVIP

椎管内镇痛药物的应用 天津医科大学总医院 王国林 2007-8-25山东 Neuraxial drug administration Techniques that deliver drugs in close proximity to the spinal cord----intrathecally into CSF or epidurally into the fatty tissues surrounding the dura, by injection or infusion. 椎管内麻醉的机制CNS drugs 2006;20(11):917-933 Spinal anaesthesis Epidural anaesthesia 椎管内麻醉应用的药物 局麻药 ：利多卡因、 布比卡因、 罗哌卡因、左旋布比卡因 阿片类： 吗啡、哌替啶、芬太尼、苏芬太尼 alpha-adrenergic receptors antagonist：可乐定、右旋美托咪啶 其他：新斯的明、氯胺酮、咪唑安定 ，腺苷、 ziconotide (齐考诺肽） 局麻药 Produce reversibale blockade of sodium channels within nervous tissues hinder the transmission of peripheral nerve impulses. - short-acting drug-------lidocaine - three longer-acting structurally related compounds--- bupivacaine,levobupivacaine and ropivacaine Often co-administered with adjunctive agents(opioids and non-opioids) - utilize the synergistic analgesic properties - improve the quality and duration of sensory block - limit adverse effects such as motor blockade Carr DB,et al “ Acute Pain” The Lancet June 1999 Indian J. Anaesth.2004:48(1):13-24CURRENT CONCEPTS IN NEURAXIAL ADMINISTRATION OF OPIOIDS AND NON-OPIOIDS : AN OVERVIEW AND FUTURE PERSPECTIVES 椎管内阿片类药物的应用进展 The identification of opioid receptors has opened new horizons in pain management. “Any opioid administered anywhere in the body will eventually produce analgesia” Benjamine Rush, 1818 1900 ----- N.Racoviceanu-pitesti of Romania. The first report of the use of opioids for the intrathecal route. injected morphine and cocaine for intrathecal anaesthesia 1901 -----Katawata of Japan used 10 mg intrathecal (IT) morphine with the local anaesthetic eucaine in two cancer patients. 1976 ----- Yaksh and Rudy were the first investigators to demonstrate direct opioid analgesia at the spinal cord level (rats experiment). 1979 ----- Wang et al. spinal morphine in patients. 1979 ----- Behar et al. epidural opioids to