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Erschienen in: Current Anesthesiology Reports 3/2019

14.05.2019 | Regional Anesthesia (P Kukreja, Section Editor)

Local Anesthetic Additives for Regional Anesthesia: a Review of Current Literature and Clinical Application

verfasst von: Promil Kukreja, Lisa MacBeth, Joel Feinstein

Erschienen in: Current Anesthesiology Reports | Ausgabe 3/2019

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Abstract

Purpose of Review

Improving perioperative pain management with regional anesthesia has become prevalent and extremely important, due in part to the opioid epidemic and increased emphasis on enhanced recovery after surgery (ERAS) protocols. Perineural catheters offer extended duration of nerve blockade as compared with single dose of local anesthetic at the cost of increased risk of catheter-related complications like displacement and higher infection rate. Also, many practices lack the infrastructure to manage catheters. We are continuously exploring options to extend block duration without catheters, and local anesthetic additives offer a viable option to prolong the benefits of plain local anesthetics.

Recent Findings

A recent randomized cross-over study has suggested that the efficacy of local anesthetic additives like dexamethasone on the duration of nerve block remains uncertain despite several supporting systematic reviews and meta-analysis data.

Summary

This article reviews current literature to provide clinically relevant information about common nerve block additives, describing rationale for their use, effect on block onset, extension of block duration, and safety profiles of the additives.
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Zurück zum Zitat •• YaDeau JT, Paroli L, Fields KG, Kahn RL, LaSala VR, Jules-Elysee KM, et al. Addition of dexamethasone and buprenorphine to bupivacaine sciatic nerve block. Reg Anesth Pain Med. 2015;40:321–9. This randomized study investigated the effect of combination of perineural additives dexamethasone and buprenorphine on pain scores, block duration, and opioid use after foot and ankle surgery. PubMedPubMedCentral •• YaDeau JT, Paroli L, Fields KG, Kahn RL, LaSala VR, Jules-Elysee KM, et al. Addition of dexamethasone and buprenorphine to bupivacaine sciatic nerve block. Reg Anesth Pain Med. 2015;40:321–9. This randomized study investigated the effect of combination of perineural additives dexamethasone and buprenorphine on pain scores, block duration, and opioid use after foot and ankle surgery. PubMedPubMedCentral
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Zurück zum Zitat •• Turner JD, Dobson SW, Henshaw DS, Edwards CJ, Weller RS, Reynolds JW, et al. Single-injection adductor canal block with multiple adjuvants provides equivalent analgesia when compared with continuous adductor canal blockade for primary total knee arthroplasty: a double-blinded, randomized, controlled, equivalency trial. J Arthroplast. 2018;33:3160–6. This randomized controlled study compared a single injection of local anesthetic bupivacaine adductor canal block with adjuvants clonidine, dexamethasone, buprenorphine, and epinephrine to continuous adductor canal block. •• Turner JD, Dobson SW, Henshaw DS, Edwards CJ, Weller RS, Reynolds JW, et al. Single-injection adductor canal block with multiple adjuvants provides equivalent analgesia when compared with continuous adductor canal blockade for primary total knee arthroplasty: a double-blinded, randomized, controlled, equivalency trial. J Arthroplast. 2018;33:3160–6. This randomized controlled study compared a single injection of local anesthetic bupivacaine adductor canal block with adjuvants clonidine, dexamethasone, buprenorphine, and epinephrine to continuous adductor canal block.
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Zurück zum Zitat •• Marhofer P, Columb M, Hopkins PM, et al. Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers. Br J Anaesth. 2019; (Article in press). This randomized cross-over study in volunteers has suggested uncertainty about the efficacy of dexamethasone on the duration of peripheral nerve blockade. •• Marhofer P, Columb M, Hopkins PM, et al. Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers. Br J Anaesth. 2019; (Article in press). This randomized cross-over study in volunteers has suggested uncertainty about the efficacy of dexamethasone on the duration of peripheral nerve blockade.
Metadaten
Titel
Local Anesthetic Additives for Regional Anesthesia: a Review of Current Literature and Clinical Application
verfasst von
Promil Kukreja
Lisa MacBeth
Joel Feinstein
Publikationsdatum
14.05.2019
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 3/2019
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-019-00334-z

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