微脂體在局部麻醉與止痛的應用

Application of liposome on anesthesia and analgesia: a review

過短的作用時間是目前局部麻醉藥的一大限制。近期有許多研究著重於延長局部麻醉藥作用時間的方式，而微脂體是最具潛力的方式之一。美國食品藥物管理局已經批准載有bupivacaine的微脂體應用在手術傷口局部浸潤和橫腹神經阻斷術（TAP block）上。近來許多臨床試驗在檢測載有bupivacaine的微脂體在胸腔，骨科，腹部手術及周邊神經阻斷上的效用及安全性。大多數的臨床試驗顯示其有助於減少術後疼痛，術後鴉片類藥物使用，減少住院天數和花費，但在周邊神經阻斷的效果仍有爭議。也有動物研究成功利用近紅外光的照射來調控載有鈉離子通道阻斷藥物的微脂體重複性釋放，為一新穎的增加作用時間方式。

Limted therapeutic duration is an important clinic concern for local anesthetic agents.Prolonged duration of local anesthetics is thus actively investigated and liposome is one of the most promising delivery system to extend the therapeutic duration. Liposome loaded with bupivacaine(liposomal bupivacaine) had been approved by Food and Drug Administration in United States using in local surgical wound infiltration and transversus abdominis plane blocks.There are several clinical trials examining the safety and efficacy of liposomal bupivacaine in thoracic,orthopedic, abdominal surgeries and peripheral nerve block. Decrease in post-operative pain, admission cost, length of stay and post-operative consumption of opioid were generally revealed but the efficacy in nerve block was still under debate.Novel application of liposome including encapsulated site-1 sodium channel blocker and repeatable release controlled by near-infrared light is also an emerging method conducted in animal models. In this review, we presented the recent clinical results and the possible future for liposome.