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[Tachyphylaxis to local anesthetics].

P Lipfert1

  • 1Abteilung für Experimentelle Anaesthesiologie des Zentrums für Anaesthesiologie, Universität, Düsseldorf.

Regional-Anaesthesie
|January 1, 1989
PubMed
Summary

Tachyphylaxis, a reduced effectiveness of local anesthetics after repeated doses, is not linked to drug properties or administration methods. Pharmacokinetic factors, rather than pharmacodynamic ones, may underlie this phenomenon.

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuroscience

Context:

  • Tachyphylaxis to local anesthetics is a clinically relevant phenomenon impacting regional anesthesia.
  • Understanding tachyphylaxis is crucial for optimizing pain management strategies.
  • Pseudotachyphylaxis, caused by external factors, can mimic true tachyphylaxis.

Purpose:

  • To define tachyphylaxis to local anesthetics.
  • To explore potential mechanisms, including pharmacokinetic and pharmacodynamic factors.
  • To discuss the clinical significance and ongoing debate surrounding tachyphylaxis.

Summary:

  • Tachyphylaxis is a decrease in local anesthetic effectiveness after repeated equal doses, necessitating dose escalation.
  • It is independent of anesthetic structure, duration, or administration technique.
  • Proposed mechanisms involve pharmacokinetic changes (e.g., perineural pH) and pharmacodynamic alterations, with evidence favoring pharmacokinetic roles.

Impact:

  • Clarifies the definition and characteristics of local anesthetic tachyphylaxis.
  • Highlights the inconclusive nature of current understanding regarding its mechanisms.
  • Suggests a potential direction for future research focusing on pharmacokinetic alterations.

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