TY - JOUR
T1 - Peripheral Regional Anesthesia Using Local Anesthetics
T2 - Old Wine in New Bottles?
AU - Gasteiger, Lukas
AU - Kirchmair, Lukas
AU - Hoerner, Elisabeth
AU - Stundner, Ottokar
AU - Hollmann, Markus W.
N1 - Funding Information: This project was supported solely by Departmental Resources. Publisher Copyright: © 2023 by the authors.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. At present, liposomal bupivacaine is the most popular, non-opioid, controlled drug delivery system, but its duration of action, which is still controversially discussed, and its expensiveness have decreased initial enthusiasm. Continuous techniques can be seen as an elegant alternative for providing a prolonged duration of analgesia, but for logistic or anatomical reasons, they are not always the best choice. Therefore, focus has been directed towards the perineural and/or intravenous addition of old and established substances. As for perineural application, most of these so-called ‘adjuvants’ are used outside their indication, and their pharmacological efficacy is often not or only poorly understood. This review aims to summarize the recent developments for prolonging the duration of regional anesthesia. It will also discuss the potential harmful interactions and side effects of frequently used analgesic mixtures.
AB - During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. At present, liposomal bupivacaine is the most popular, non-opioid, controlled drug delivery system, but its duration of action, which is still controversially discussed, and its expensiveness have decreased initial enthusiasm. Continuous techniques can be seen as an elegant alternative for providing a prolonged duration of analgesia, but for logistic or anatomical reasons, they are not always the best choice. Therefore, focus has been directed towards the perineural and/or intravenous addition of old and established substances. As for perineural application, most of these so-called ‘adjuvants’ are used outside their indication, and their pharmacological efficacy is often not or only poorly understood. This review aims to summarize the recent developments for prolonging the duration of regional anesthesia. It will also discuss the potential harmful interactions and side effects of frequently used analgesic mixtures.
KW - adjuvants
KW - local anesthetics
KW - prolongation of action
KW - regional anesthesia
UR - http://www.scopus.com/inward/record.url?scp=85148950649&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm12041541
DO - https://doi.org/10.3390/jcm12041541
M3 - Review article
C2 - 36836081
SN - 2077-0383
VL - 12
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 4
M1 - 1541
ER -