Local anaesthetics and adjuvants – future developments

Abstract

Summary The introduction of local anaesthesia some years after the first public demonstration of general anaesthesia not surprisingly created less excitement and interest amongst both the public and the medical profession. However, in its own way, a new revolution was happening. Local anaesthesia produced an increase in the choice of anaesthetic techniques available to practitioners and patients. In common with general anaesthesia, the choice of agents remained very limited for the first six decades, and interest in the practice of local, regional or central neuraxial blockade and the development of new techniques and drugs were hampered by perceived safety issues even as late as the second half of the 20th century. It is only in the last few years that, with an apparent renaissance in the use of local anaesthesia, the pace of development has picked up. As the use and range of techniques has increased, so has interest in solving some of the longstanding problems with the available drugs.

Effects of opioids on local anesthesia in the rat: a codeine and tramadol study

“…Anesthetic adjuvants now represent some of the most important developments in current research in this area. 2 They are considered well tolerated and have few systemic effects following peripheral administration; however, COD is also a potent opioid analgesic with a complex mechanism of action. Its performance as an analgesic on the PNS is excellent, i.e., up to twice as good as that of the CNS.…”

“…icity incidences. 2 In regard to pain control, the literature documents attempts to find the best therapy for each procedure. As reported in recent papers, it is evident that the association of more than one drug promotes better results than following the established conventional therapies.…”

Influência da codeína, associada ou não ao anestésico local, na duração do bloqueio sensitivo, motor e proprioceptivo do nervo ciático de rato

“…Mesmo com tanto advento no desenvolvimento das ALs ainda se espera o desenvolvimento do AL ideal. Embora os ALs modernos sejam efetivos e seguros para a maioria das práticas clínicas, ainda há uma intensa pesquisa por agentes de longa duração de ação, melhor seletividade nervosa, menores graus de bloqueio motor e menores incidência de toxicidade sistêmica (Wiles;Nathansom, 2010).…”

“…Sendo que até agora os opióides e o sistema de disponibilidade lipossimal são considerados os maiores frutos nas investigações (Wiles;Nathansom, 2010).…”

“…Age como um analgésico através da afinidade por receptores µ-opióides, por agonistas alfa 2-adrenoreceptores, efeitos serotoninérgicos e pela inibição da recaptação de noradrenalina e 5-hidroxitriptamina (serotonia) (Wiles;Nathanson, 2010 (Lehmann, 1997).…”