GasGasGas - Anaesthetic Science for Anaesthesia! Peri-Neural Local Anaesthetic Adjuncts for Regional Anaesthesia
Aug 29, 2025
Dive into the fascinating world of peri-neural local anaesthetic adjuncts! Discover the rationale behind extending block duration and learn about effective strategies like vasoconstrictors and modified-release formulations. Explore non-hypnotic options such as adrenaline and magnesium, alongside the effects of sodium bicarbonate and hyaluronidase. Find out about the innovative uses of ketamine and midazolam, and the benefits of opioid adjuncts like buprenorphine. The discussion wraps up with insights on liposomal bupivacaine and practical recommendations.
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Off‑Label Use Raises Safety Questions
- Peri‑neural adjuncts are largely off‑label and raise neurotoxicity concerns that limit widespread use.
- Animal data dominate safety signals, so clinicians remain cautious about routine clinical adoption.
Assess Pharmacology And Avoid Preservatives
- Check pharmacokinetics, pharmacodynamics and local toxicity before adding an adjunct to a block.
- Avoid preservatives and unknown agents near nerves or intrathecally to reduce risk of nerve injury.
Adrenaline Helps Some LAs More Than Others
- Adrenaline shortens onset and prolongs some LAs by vasoconstriction and reduced uptake.
- It helps more with lidocaine than bupivacaine and is less suitable for neuroaxial spaces.