Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs

AuthorAmber N. Edinoffen
AuthorGarrett M. Houken
AuthorShilpa Patilen
AuthorHarish Bangalore Siddaiahen
AuthorAaron J. Kayeen
AuthorPriya Shelvan Iyengaren
AuthorElyse M. Cornetten
AuthorFarnad Imanien
AuthorKamran Mahmoudien
AuthorAdam M. Kayeen
AuthorRichard D. Urmanen
AuthorAlan D. Kayeen
OrcidAmber N. Edinoff [0000-0001-7436-6206]en
OrcidAaron J. Kaye [0000-0002-2481-7897]en
OrcidElyse M. Cornett [0000-0001-7961-3931]en
OrcidFarnad Imani [0000-0003-0814-0772]en
OrcidKamran Mahmoudi [0000-0002-5077-5280]en
OrcidAdam M. Kaye [0000-0002-7224-3322]en
OrcidRichard D. Urman [0000-0002-0516-5977]en
OrcidAlan D. Kaye [0000-0003-2464-0187]en
Issued Date2021-06-30en
AbstractAdjuvant drugs for peripheral nerve blocks are a promising solution to acute postoperative pain and the transition to chronic pain treatment. Peripheral nerve blocks (PNB) are used in the brachial plexus, lumbar plexus, femoral nerve, sciatic nerve, and many other anatomic locations for site-specific pain relief. However, the duration of action of a PNB is limited without an adjuvant drug. The use of non-opioid adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs, can extend the duration of local anesthetics and reduce the dose-dependent adverse effects of local anesthetics. Tramadol is a weak opioid that acts as a central analgesic. It can block voltage-dependent sodium and potassium channels, cause serotonin release, and inhibit norepinephrine reuptake and can also be used as an adjuvant in PNBs. However, tramadol’s effectiveness and safety as an adjuvant to local anesthetic for PNB are inconsistent. The effects of the adjuvants on neurotoxicity must be further evaluated with further studies to delineate the safety in their use in PNB. Further research needs to be done. However, the use of adjuvants in PNB can be a way to help control postoperative pain.en
DOIhttps://doi.org/10.5812/aapm.117197en
KeywordPeripheral Nerve Blocken
KeywordPostoperative Painen
KeywordAdjuvant Medicationsen
KeywordAlpha-2 Agonistsen
KeywordNSAIDsen
KeywordDexamethasoneen
KeywordMidazolamen
PublisherBrieflandsen
TitleAdjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugsen
TypeReview Articleen

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