椎管内镇痛药物的应用.ppt
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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):13-24
CURRENT 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 manage acute
postoperative pain.
阿片药应用于椎管内麻醉的优势
> Greater anaesthesia success rate
> Faster onset of surgical block than LA alone
> Improved intraoperative analgesia (enhances sensory block without increased motor block)
> Permits lower LA dose with faster recovery from spinal anaesthesia
> Postoperative analgesia beyond the duration of LA motor block
> Less nausea and/or vomiting during cesarean delivery
> Shorter time to extubation, significantly reduces MAC
阿片药应用于椎管内麻醉的作用机制
"The clinical practice of spinal morphine administration
for pain relief is based on observations in animals that
opioid receptors exist in the spinal cord and intrathecal
injections of opioids in those species (mostly rats) lead
to antinociceptive effects."
European Journal of Anaesthesiology 2004;21:179-185
Mechanism of Action: Reaching Receptors ......
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):13-24
CURRENT 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 manage acute
postoperative pain.
阿片药应用于椎管内麻醉的优势
> Greater anaesthesia success rate
> Faster onset of surgical block than LA alone
> Improved intraoperative analgesia (enhances sensory block without increased motor block)
> Permits lower LA dose with faster recovery from spinal anaesthesia
> Postoperative analgesia beyond the duration of LA motor block
> Less nausea and/or vomiting during cesarean delivery
> Shorter time to extubation, significantly reduces MAC
阿片药应用于椎管内麻醉的作用机制
"The clinical practice of spinal morphine administration
for pain relief is based on observations in animals that
opioid receptors exist in the spinal cord and intrathecal
injections of opioids in those species (mostly rats) lead
to antinociceptive effects."
European Journal of Anaesthesiology 2004;21:179-185
Mechanism of Action: Reaching Receptors ......
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