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Systemische Effekte der Amid-Lokalanästhetika

Alte Substanzen, neue Wunderwaffen?

Systemic effects of amide-linked local anesthetics

Old drugs, new magic bullets?

  • Regionalanästhesie
  • Published:
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Zusammenfassung

Neben den bekannten analgetischen Wirkungen der Amidlokalanästhetika durch Blockade des spannungsabhängigen Natriumkanals besitzen diese Substanzen eine Vielzahl weiterer positiver Eigenschaften, die das Ergebnis einer Operation positiv beeinflussen könnten. Experimentelle und auch klinische Studien suggerieren die Möglichkeit einer verbesserten postoperativen Erholung, einer Verminderung der Inzidenz von chronischen Schmerzen, einer Bewahrung der endothelialen Barriere im akuten Lungenschaden oder der Verhinderung einer möglichen Metastasierung maligner Zellen durch systemische Effekte von Lokalanästhetika. Mechanistische Untersuchungen konnten zudem bereits „neue Ziele“, wie beispielsweise die Hemmung spinaler Glycintransporter oder einer durch Tumornekrosefaktor α induzierten inflammatorischen Signalkaskade, identifizieren. Die Aufklärung weiterer möglicher Mechanismen dieser Effekte ist ebenso Bestandteil aktiver anästhesiologischer Forschung wie auch die Translation der bisher vielversprechenden Ansätze aus dem Labor hinein in die klinische Anwendung.

Abstract

Besides the well-known analgesic effects of amide-linked local anesthetics exerted via the inhibition of the voltage-gated sodium channel, these substances also possess a certain number of properties, which bear the potential to positively influence the outcome after surgery. The results of several experimental as well as clinical studies suggest the possibility of an enhanced recovery after surgery, reduction in the incidence of chronic pain, preservation of endothelial barrier function during acute lung injury and the prevention of metastasis of solid tumors by systemic effects of local anesthetic administration. Mechanistic studies were able to identify several “new targets”, such as the inhibition of spinal glycine transporters or of inflammatory signaling as induced by tumor necrosis factor alpha. Further elucidation of these mechanistic pathways as well as the translation of these promising experimental results into clinical practice is a crucial component of research activities in the field of anesthesia.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig (AöR), Liebigstraße 20, 04103, Leipzig, Deutschland

    T. Piegeler &  R. Werdehausen

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  1. T. Piegeler
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  2. R. Werdehausen
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Correspondence to T. Piegeler.

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Interessenkonflikt

T. Piegeler und R. Werdehausen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

T. Piegeler und R. Werdehausen sind Mitglieder des Wissenschaftlichen Arbeitskreises Wissenschaftlicher Nachwuchs (WAKWiN) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI).

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Piegeler, T., Werdehausen, R. Systemische Effekte der Amid-Lokalanästhetika. Anaesthesist 67, 525–528 (2018). https://doi.org/10.1007/s00101-018-0453-2

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  • DOI: https://doi.org/10.1007/s00101-018-0453-2

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