Local Anesthetic Adjuvants in Regional Anesthesia

Thomas Hopkins, M.D.
Resident Physician

Mitchell Fingerman
Assistant Professor

Duke University Medical Center
Department of Anesthesiology
Durham, North Carolina

Introduction - TOP

Peripheral nerve blockade can be accomplished by applying local anesthetics and other agents from a variety of pharmacological classes to inhibit the conduction of electrical signals within nerve fibers of the peripheral nervous system.1  Peripheral nerve blockade is classically sub-categorized into minor and major nerve blocks.  Minor nerve blocks are defined as procedures directed at isolating a single peripheral nerve, while major blocks are described as procedures involving a single nerve at a proximal location (i.e. femoral nerve block), two or more isolated nerves, or a nerve plexus.1 

Classically, neuraxial anesthesia refers to placement of local anesthetic in close proximity to nerves in the central nervous system and includes spinal, epidural and caudal techniques.  Following its serendipitous discovery by Corning in the 1880s, neuraxial anesthesia endured advancements in the safety profile associated with general anesthesia during the twentieth century and has become an extraordinarily popular method of providing both surgical anesthesia and postoperative analgesia over the past decade.  Many critics attribute this success to the diverse clinical application, favorable safety profile and its vast potential to provide profound clinical analgesia for patients in the perioperative period.   Furthermore, following the introduction of continuous catheter techniques and combined spinal-epidural anesthesia, there has been a renewed interested in research focusing on the development of local anesthetic adjuvants for neuraxial anesthesia that will provide increased sensory block intensity without compromising the speed of motor function recovery.

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