Perineural adjuncts for peripheral nerve block

Desai, Neel; Albrecht, Éric; El‐Boghdadly, Kariem

doi:10.1016/j.bjae.2019.05.001

Cited by 30 publications

(29 citation statements)

References 25 publications

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“…The presence of adrenaline can also alert the physician to unintentional intravascular injection. Ropivacaine is a vasoconstrictor and, therefore, the addition of adrenaline does not increase the duration of action or maximum safe dose [21] but increases the susceptibility to neurotoxicity due to decreased perfusion to the axon [22, 23]. These negative effects on blood flow are cumulative; for example, lidocaine 2% with adrenaline 5 μg.ml −1 will reduce neural blood flow by around 80% [24].…”

Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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Summary Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long‐ and short‐acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non‐steroidal anti‐inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non‐steroidal anti‐inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose‐dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.

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Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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“…Perineural injection of clonidine and dexmedetomidine can have adverse effects such as bradycardia, hypotension, and sedation. 35 The onset of sensory and motor block was found to be considerably hastened with perineural administration than intravenous administration. The duration of sensory and motor block was also considerably prolonged with perineural dexmedetomidine than intravenous dexmedetomidine.…”

Section: Discussionmentioning

confidence: 97%

Clonidine and dexmedetomidine as adjuvant to ropivacaine for supraclavicular brachial plexus block during upper limb surgery: A comparative study

et al. 2022

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Background: Various adjuvants are added to local anesthetics to increase the duration of block during supraclavicular brachial plexus (SCBP) block. Dexmedetomidine, a newer and potent alpha2 receptor agonist, has 10 times higher selectivity than clonidine. Many studies have already evaluated the efficacy of clonidine and dexmedetomidine as perineural adjuvants and have reported wide variations in the prolongation of post-operative analgesia. Some studies have reported the absence of adjuvant’s effect while a few have not focused all the facets of block characteristics. Aims and Objectives: The aim of the study was to compare the efficacy of clonidine and dexmedetomidine as adjuvant to ropivacaine during SCBP block for the upper limb surgeries, in terms of duration of post-operative analgesia (Primary outcome). The onset and duration of sensory and motor block, and adverse effects, if any, were observed. Materials and Methods: Ninety patients, aged between 40 and 60 years of either sex, undergoing upper limb surgery, were randomly allocated in to three groups to receive either 30 ml of 0.5% ropivacaine and 2 ml saline (Group R, n=30) or 30 ml 0.5% ropivacaine plus clonidine (1 mcg/kg) plus saline to make a total volume 32 ml (Group C, n=30), or 30 ml 0.5% ropivacaine and dexmedetomidine (1 mcg/kg) plus saline to make a total volume 32 ml (Group D, n=30). The duration of post-operative analgesia, other block characteristics, and adverse events, if any, was assessed. Results: Mean duration of post-operative analgesia was found to be considerably higher in dexmedetomidine group compared with clonidine group and ropivacaine alone group (664.13 vs. 551.77 vs. 465.47, respectively, P<0.001). The duration of sensory and motor block was considerably longer in dexmedetomidine group compared with clonidine and control group. Adverse events were comparable among the three groups. Conclusion: Dexmedetomidine appears to be a better alternative to clonidine as adjuvant in terms of prolonged post-operative analgesia and comparable adverse events.

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“…The duration of action of local anesthetics in PNB varies but may last up to 24 hours. Patients who have had a single-shot PNB may complain of slightly greater postoperative discomfort between 16 and 24 h compared with those who have had only systemic analgesics [64]. Rebound pain may occur after single-shot PNBs, resulting in sleep disturbances, difficulties employing enhanced recovery and physiotherapy protocol, and increased consumption of opioids and related side effects [64].…”

Section: Adjuncts To Regional Nerve Blocksmentioning

confidence: 99%

Acute Post-Operative Pain Management

Khatib¹,

Razvi²,

Shaikh³

et al. 2023

Updates in Anesthesia - The Operating Room and Beyond

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Despite major advances in the field of anesthesia and medicine, postoperative pain continues to be undermanaged in a significant proportion of patients. The consequences of undermanaged pain are deleterious for both patients and the healthcare system. This review aims to give the readers a practical and updated approach to acute postoperative pain management. This chapter deals with the definition of pain, the physiology and pathophysiology of pain, and various approaches to the management of acute pain. A review of the literature was done to understand the methods of pain management with a major focus on the literature of the last decade (2010–2022). A literature search was done on PubMed and Google Scholar using keywords “acute postoperative pain” and “pain physiology.” The research papers on the basics of pain physiology, the prevalence of acute post-operative pain and methods of acute postoperative pain management were reviewed. A brief practical approach for acute postoperative pain using pharmacological and non-pharmacological approaches and a brief discussion have been done on the approach for special group of patients. The management of acute postoperative pain can be done using various pharmacological and non-pharmacological methods. The approach for each patient has to be tailored depending on the individual patient’s needs.

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Perineural adjuncts for peripheral nerve block

Cited by 30 publications

References 25 publications

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Clonidine and dexmedetomidine as adjuvant to ropivacaine for supraclavicular brachial plexus block during upper limb surgery: A comparative study

Acute Post-Operative Pain Management

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