Common peripheral Nerve Block Adjuvants in Combination with Local Anaesthetics

Abstract

Effective postoperative pain control is crucial. Various techniques are used for this purpose, including continuous nerve blocks, liposomal local anesthetics, and adjuvants added to local anesthetics. While continuous blocks offer advantages, they have challenges and failure rates. Liposomal local anesthetics also have limitations. Adjuvants, categorized as "old" and "new," can extend regional block duration. Epinephrine primarily prolongs local anesthetic effects through localized vasoconstriction. Sodium bicarbonate alkalization benefits specific peripheral nerve blocks but has varying outcomes. Alpha2 adrenoreceptor agonists like clonidine and dexmedetomidine can extend analgesia but may lead to side effects through systemic absorption. Opioid agonists such as buprenorphine and tramadol yield variable results depending on the surgical type, with potential benefits through intravenous or intramuscular administration. The review further emphasizes the significance of adjuvants like corticosteroids and NMDA (N-Methyl-D-Aspartate) receptor antagonist magnesium sulfate in consistently prolonging analgesia when combined with local anesthetics. The comprehensive analysis of peripheral nerve block adjuvants provides valuable insights for healthcare practitioners to navigate this dynamic field and optimize pain management strategies. It underscores the evolving landscape and the necessity of considering patient-specific factors, surgical context, and available evidence in the selection of adjuvants. The call for further research highlights the ongoing efforts to refine the use of adjuvants for safe and effective postoperative pain management.