Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review.

Details

Serval ID
serval:BIB_CFC1F24BBD07
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review.
Journal
Anaesthesia
Author(s)
Desai N., Kirkham K.R., Albrecht E.
ISSN
1365-2044 (Electronic)
ISSN-L
0003-2409
Publication state
Published
Issued date
01/2021
Peer-reviewed
Oui
Volume
76 Suppl 1
Pages
100-109
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Moderate-to-severe postoperative pain persists for longer than the duration of single-shot peripheral nerve blocks and hence continues to be a problem even with the routine use of regional anaesthesia techniques. The administration of local anaesthetic adjuncts, defined as the concomitant intravenous or perineural injection of one or more pharmacological agents, is an attractive and technically simple strategy to potentially extend the benefits of peripheral nerve blockade beyond the conventional maximum of 8-14 hours. Historical local anaesthetic adjuncts include perineural adrenaline that has been demonstrated to increase the mean duration of analgesia by as little as just over 1 hour. Of the novel local anaesthetic adjuncts, dexmedetomidine and dexamethasone have best demonstrated the capacity to considerably improve the duration of blocks. Perineural dexmedetomidine and dexamethasone increase the mean duration of analgesia by up to 6 hour and 8 hour, respectively, when combined with long-acting local anaesthetics. The evidence for the safety of these local anaesthetic adjuncts continues to accumulate, although the findings of a neurotoxic effect with perineural dexmedetomidine during in-vitro studies are conflicting. Neither perineural dexmedetomidine nor dexamethasone fulfils all the criteria of the ideal local anaesthetic adjunct. Dexmedetomidine is limited by side-effects such as bradycardia, hypotension and sedation, and dexamethasone slightly increases glycaemia. In view of the concerns related to localised nerve and muscle injury and the lack of consistent evidence for the superiority of the perineural vs. systemic route of administration, we recommend the off-label use of systemic dexamethasone as a local anaesthetic adjunct in a dose of 0.1-0.2 mg.kg <sup>-1</sup> for all patients undergoing surgery associated with significant postoperative pain.
Keywords
Anesthesia, Conduction/methods, Anesthetics, Local, Conscious Sedation, Humans, Hypnotics and Sedatives, Nerve Block/methods, Peripheral Nerves, local anaesthetic adjuncts, local anaesthetics, nerve block
Pubmed
Web of science
Open Access
Yes
Create date
26/01/2021 15:25
Last modification date
29/01/2021 6:26
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