G. Vaishnavi, M. Durga Srinivasa Rao, P. Venkatesh, D. Hepcykalarani, R. Prema
Jagan’s Institute of Pharmaceutical Sciences, Jangalakandriga (v) - 524326,
Muthukur (M), Nellore (Dist.), A.P., India.
*Corresponding Author E-mail: gvaishnavipharma@gmail.com
ABSTRACT:
An anesthitic or painkiller is any member of the group of drugs used to achieve analgesia, relief from pain, without losing consciousness. An analgesic is derived from Greek words: an – without and algia- pain. Analgesic drugs act in various ways on the peripheral and central nervous system. They are distinct from Anaesthetics, which temporarily affect, and in some instances completely eliminate sensation. When choosing analgesics, the severity and response to other medications determines the choice of agent; the World Health Organization (WHO) pain ladder specifies mild analgesics as its first step. A wide variety of plants have been found to have analgesic or anesthetic effects, e.g. coca, clove and cinchona. Various natural anaesthetic herbs; (Local anaesthetic herbs: Coca, clove, cinchona & spilanthes) and (General anaesthetic herbs: Valerian, aloe vera, liquorice & tulsi) were discussed. This review gives information about different natural analgesics, along with their biological source, chemical composition and mechanism of action.
KEYWORDS: Anesthetic herbs, coca, clove, cinchona, spilanthes, valerian, aloe vera, glyccyrhiza, ocimum.
INTRODUCTION:
A patient under the effect of anesthetic drug is referred to as being anaesthetized. Anesthesia refers to painless performance of medical procedure that would otherwise cause severe or intolerable pain to an un-anesthetized patient, or would otherwise be technically unfeasible. Three broad categories of anesthesia are:
General anesthesia:
Suppresses central nervous system activity and results in unconsciousness and total lack of sensation. A patient receiving general anesthesia can lose consciousness with either intravenous agents or inhalation agents
Local anesthesia:
Will block transmission of nerve impulses from a specific part of the body. Depending on the situation, this may be used either on its own (in which case the patient remains conscious), or in combination with general anesthesia or sedation. Drugs can be targeted at peripheral nerves to anaesthetize an isolated part of the body only, such as numbing a tooth for the dental work or using a nerve block to inhibit sensation in an entire limb. Alternatively, epidural, spinal anesthesia, or a combined technique can be performed in the region of the central nervous system itself, suppressing all incoming sensation from nerves outside the area of the block. The risks of complications during or after anesthesia are often difficult to separate from those of the procedure for which anesthesia is being administered, but in the main they are related to three factors; the health of the patient, the complexity (and stress) of the procedure itself, and the anesthetic technique. Of these factors, the health of the patient has the greatest impact. Major preoperative risks can include death, Heart attack, and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and hospital readmission. Some conditions, like local anesthetic toxicity, airway trauma or malignant hyperthermia, can be more directly attributed to specific anesthetic drugs and techniques.
Sedatives:
Suppresses the central nervous system to a lesser degree, inhibiting both anxiety and creation of longterm memories without resulting in unconsciousness.
As per ‘International Association for the Study of Pain (IASP)’; pain is a distressing feeling often caused by intense or damaging stimuli is the widely used definition defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Nociception is the more correct term for the experimental study of pain because it is objectively measured through behavior in animals and human like, e.g., withdrawal reflexes, verbal ratings. The first attempts at general anesthesia were probably herbal remedies administered in prehistory. Alcohol is one of the oldest known sedatives and it was used in ancient Mesopotamia thousands of years ago. The Sumerians are said to have cultivated and harvested the opium poppy in lower Mesopotamia as early as 3400 BC.1-8
Properties of an ideal anaesthetic herb:9
· Reversible action
· Non irritant
· Produce no secondary local reaction (No allergic reactions)
· No systemic toxicity
· Rapid onset
· Sufficient duration
· Potent
· Sufficient penetrating properties
· Stable in solution and undergoes biotransformation in body
· Can be sterilized without deterioration
· Not interfere with healing of local tissues
· Have vasoconstrictor action
· Not expensive
Toxicity of anaesthetic herbs:10
· Major reactions occur due to over dosing of anaesthetics. Transient CNS stimulation followed by CNS and cardiovascular depression may occurs.
· Very profound CNS stimulation leads to convulsions.
· Rarely systemic allergic reactions are seen.
· Higher the level of spinal anaesthesia more intense will be hypertension.
· Sometimes spinal cord or nerve root damage may also occur.
Classification of anaesthetic herbs:11,12
Local anaesthetic herbs:
Coca, clove, cinchona and spilanthes
General anaesthetic herbs:
Valerian, aloe vera, liquorice and tulsi
LOCAL ANAESTHETIC HERBS:
Fig.1. Local anaesthetic herbs; A) Erythroxylum coca; B) Syzygium aromaticum; C) Cinchona officinalis and D) Spilanthes acmella
Bological source:
Coca is obtained from dried leaves of Erythroxylum coca, belonging to the family Erythroxylaceae.
Geographical source:
The plant is grown as a cash crop in Argentine Northwest, Colombia, Ecuador, and Peru, even in areas where its cultivation is unlawful. Some reports say that the plant is being cultivated in the south of Mexico.
Chemical constituents:
0.7-1.5% cocaine, tannic acid, resin, tannin, chlorophyll, theine and salts of lime.
Activity:
Cocaine prevents the generation and conduction of the nerve impulse. The primary site of action is the cell membrane. Local anaesthetics blocks conduction by decreasing or preventing the large transient increase in the permeability of excitable membranes to sodium channels (voltage gated sodium channel). As the anaesthetic action progressively develops in a nerve, the threshold for electrical excitability gradually increases, the rate of rise of the action potential declines, impulse conduction slows and the safety factor for conduction decreases, these factors decrease the probability of propagation of the action potential, and nerve conduction fails.
Biological source:
Cloves are the aromatic flower buds of a tree Syzygium aromaticum, belonging to the family Myrtaceae.
Geographical source:
They are native to the Maluka islands in Indonesia and are commonly used as a spice.
Chemical constituents:
85% eugenol, 15% eugenyl acetate, 10-13% tannins, oleanolic acid, vanillin, chromene-eugenin, 7% β-caryophyllene, methyl-n-amyl ketone and esters.
Activity:
The capsaicin receptor blockade of sodium channels that reduces action potentials and serves as local anesthetic. Inhibition of prostaglandin synthesis through cyclo oxygenease and lipoygenose pathway explaining its analgesic and anti-inflammatory properties.
CINCHONA:
Biological source:
The dried bark of cinchona is obtained from Cinchona officinalis, C. calisaya, C. ledgeriana, and C. succirubra belonging to the family Rubiaceae.
Geographical source:
Cinchona is native to the tropical and forest of western South America, a few species are reportedly seen in Central America and Jamaica.
Chemical constituents:
6-7% quinine, quinidine, cinchonine, cinchonidine, 5-8% quinic acid, keno-tannic acid, 2% qinovin and kinova-tannic acid.
Activity:
Quinine and its derivatives, when brought in contact with sensory nerves, produce local anesthesia, this is used clinically in the form of the more soluble and less irritant double salts, especially Quinine urea hydrochloride. The anesthesia is more lasting than with other local anaesthetics, it may persist for several days. This is indeed to necrosis of the axis cylinders and sheaths, with subsequent regeneration. The concentration above 0.25% sometimes produces irritation, edema, and above 1% there may be sloughing. Its use has therefore greatly diminished, although some clinicians fears as exaggerated.
Biological source:
These are the dried flowering heads of Spilanthes acmella and S. oleraceae, belonging to the family Asteraceae.
Geographical source:
These herbs originated in Tropical Africa and South America and are widely distributed in the tropics and sub-tropics, including Tropical America, North Australia, Africa, India and Srilanka.
Chemical constituents:
1-2% spilanthol, isobutyl amide, choline, tannins, resin.
Activity:
When chewed the flower heads produced a remarkable tingling sensation in the mouth, a local anaesthetic and pronounced increases in saliva flow. These effects are due to spilanthol, which also has strong insecticidal and anti-microbial activities. Spilanthol shows a pronounced mouth watering effect on ingestion.
GENERAL ANAESTHETIC HERBS:
Fig.2. General anaesthetic herbs; A) Valerian officinalis; B) Aloe barbedensis; C) Glycyrrhiza glabra and D) Ocimum sanctum
Biological source:
It consists of dried rhizomes, fleshy roots; hallow stem compound leaves of Valerian officinalis, belonging to the family Valerianaceae.
Geographical source:
It is found abundant in the Western Himalayas and is reported in Afghanistan and Pakistan. Indian valerian is collected in Kashmir, Garhwal and other places in North-West Himalayas in India.
Chemical constituents:
0.05-1% alkaloids (valerine, chatinine, valeriana alkaloid XI), volatile oil with bornyl acetate, β-caryophyllene, valeranone, valerenal, bornyl isovalerate, 0.5-2% valerenic acid.
Activity:
Gamma amino butyric acid (GABA) is primary inhibitory amino acid neurotransmitter in the brain and it is synthesized from Glutamate and is stored in presynaptic vesicles. Valerian inhibit reuptake of GABA in the pre synaptic vesicles and enhances the release of GABA.
Geographical source:
Curacao aloe in West Indian islands, Cape aloe in Cape town (South Africa), Socotrine aloe in Socotra and Zanzibar islands. It is also cultivated in Europe and the North-West Himalayan region in India.
Chemical constituents:
Aloe emodin, aloin, aloesin, γ-coniceine.
Activity:
Aloevera gel extract is used. Aloevera produces anti inflammatory action by inhibiting the cyclo-oxygenase enzyme and decreases prostaglandin E2 secretion from arachidonic acid. The new anti-inflammatory compound called C-glucosyl chromone was isolated from gel extract.
Biological source:
Liquorice is the dried, peeled or unpeeled roots, rhizomes, or stolons of Glycyrrhiza glabra, belonging to the family Leguminosae.
Geographical source:
Sub-Himalayan tracts and Baluchistan. It is cultivated on a large scale in Spain, Sicily, and Yorkshire (England).
Chemical constituents:
Glycyrrhizin/glycyrrhizic acid (major glycoside), glycyrrhitic acid (aglycone), glucprpnic acid, resins, volatile oil, starch, liquiritoside; isoliquiritoside, liquiritin, isoliquiritin (flavonoid glycoside).
Activity:
Liquorice root (rhizome) commercial extracts of glycyrrhizin in ammonium salts and G. glabra alcoholic extract which produced of 4 active ingredients: hydroglia aspirin C, dehydrogol aspirin D, glycaemia and coumarin glycerin. Other ingredients of liquorice are flavonoids, coumarins, aminoacids, esteroles, liquiritin, formononetin, starch, saccharides, resin, oil essences and saponins. This herb has anti inflammatory activity.
Biological source:
Tulasi consists of the fresh and dried leaves of Ocimum sanctum and Ocimum basilicum belonging to the family Lamiaceae.
Geographical source:
It is native to Indian sub continent, and widespread as a cultivated plant throughout the South-East Asian tropics.
Chemical constituents:
0.8% volatile oil, eugenol, nerol, eugenol methyl ether, caryophyllene, terpinene-4-ol-decylaldehyde, α-selinene, α and β-pinene, camphor and carvacrol.
Activity:
Inhibition of prostaglandins, histamines, and acetylcholine.
Screening method for local anesthesia:14-22
Method:
Surface anesthesia on the cornea of rats.
Purpose and rationale:
standard test method for evaluating local anesthesia.
Fig.3. Test procedure for local anesthesia
Screening method for general anesthesia: 23-28
Method:
screening of intravenous anesthesia
Purpose and rationale:
Determination of doses for loss of righting reflex; onset and duration of action.
Fig.4. Test procedure for general anesthesia
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Received on 14.12.2019 Modified on 10.01.2020
Accepted on 05.02.2020 ©A&V Publications All right reserved
Res. J. Pharmacognosy and Phytochem. 2020; 12(1):. 52-56.
DOI: 10.5958/0975-4385.2020.00010.2