title: Local anaesthetic adjuvants: neuraxial versus peripheral nerve block.
abstract: OBJECTIVE
  To present a review of the literature on the importance and the clinical characteristics relevant to adjuvants added to local anaesthetics in neuraxial and peripheral nerve blocks.
  
  
  RESULTS
  In neuraxial anaesthesia, both opioids and alpha-2 receptor agonists have beneficial effects. Intrathecally, fentanyl and sufentanil not only improve the postoperative analgesia but also make it possible to allow a decrease in the local anaesthetic dose. When clonidine or dexmedetomidine was added to intrathecal local anaesthetics, the regression of sensory, motor block increased dose-dependently and postoperative analgesia was prolonged. The potency of intrathecal clonidine: dexmedetomidine seems to be 10: 1. In peripheral nerve block, when opioid was combined with local anaesthetics, no increased improvement in analgesia was reported in comparison with systemic controls in most of the studies, except buprenorphine. Also clonidine is controversial as an analgesic adjuvant. Special factors, such as type of local anaesthetics, block of upper or lower limb, are important for its the beneficial effect. Other adjuvants, except neuraxial low-dose neostigmine, are of minor importance.
  
  
  CONCLUSIONS
  Opioids and alpha-2 receptor agonists are important as neuraxial adjuvants to improve the quality of peroperative and postoperative analgesia in high-risk patients and in ambulatory procedures. In peripheral nerve blocks, however, some benefit is found only when clonidine is added to local anaesthetics under certain circumstances.
authors: Department of Anesthesiology and Intensive Care, University Hospital, Orebro, Sweden. kjell.axelsson@orebroll.se
authors: Kjell
authors: K
authors: Axelsson
authors: Anil
authors: A
authors: Gupta
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D006801:Humans; D009407:Nerve Block / Q000379:methods
chemical_list: D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local