Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate.

Autor:	Edinoff AN; Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA., Fitz-Gerald JS; Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA., Holland KAA; School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA., Reed JG; School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA., Murnane SE; School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA., Minter SG; School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA., Kaye AJ; Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA., Cornett EM; Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA., Imani F; Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran., Khademi SH; Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran., Kaye AM; Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA., Urman RD; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA., Kaye AD; Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
Jazyk:	angličtina
Zdroj:	Anesthesiology and pain medicine [Anesth Pain Med] 2021 Jul 05; Vol. 11 (3), pp. e117146. Date of Electronic Publication: 2021 Jul 05 (Print Publication: 2021).
DOI:	10.5812/aapm.117146
Abstrakt:	The potential for misuse, overdose, and chronic use has led researchers to look for other methods to decrease opioid consumption in patients with acute and chronic pain states. The use of peripheral nerve blocks for surgery has gained increasing popularity as it minimizes peripheral pain signals from the nociceptors of local tissue sustaining trauma and inflammation from surgery. The individualization of peripheral nerve blocks using adjuvant drugs has the potential to improve patient outcomes and reduce chronic pain. The major limitations of peripheral nerve blocks are their limited duration of action and dose-dependent adverse effects. Adjuvant drugs for peripheral nerve blocks show increasing potential as a solution for postoperative and chronic pain with their synergistic effects to increase the duration of action and decrease the required dosage of local anesthetic. N-methyl-d-aspartate (NMDA) receptor antagonists are a viable option for patients with opioid resistance and neuropathic pain due to their affinity to the neurotransmitter glutamate, which is released when patients experience a noxious stimulus. Neostigmine is a cholinesterase inhibitor that exerts its effect by competitively binding at the active site of acetylcholinesterase, which prevents the hydrolysis of acetylcholine and subsequently retaining acetylcholine at the nerve terminal. Epinephrine, also known as adrenaline, can potentially be used as an adjuvant to accelerate and prolong analgesic effects in digital nerve blocks. The theorized role of sodium bicarbonate in local anesthetic preparations is to increase the pH of the anesthetic. The resulting alkaline solution enables the anesthetic to more readily exist in its un-ionized form, which more efficiently crosses lipid membranes of peripheral nerves. However, more research is needed to show the efficacy of these adjuvants for nerve block prolongation as studies have been either mixed or have small sample sizes. Competing Interests: Conflict of Interests: There is no conflicts of interest. (Copyright © 2021, Author(s).)
Databáze:	MEDLINE
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