Local Anesthetic Additives for Regional Anesthesia: a Review of Current Literature and Clinical Application

Purpose of Review Improving perioperative pain management with regional anesthesia has become prevalent and extremely important, due in part to the opioid epidemic and increased emphasis on enhanced recovery after surgery (ERAS) protocols. Perineural catheters offer extended duration of nerve blockade as compared with single dose of local anesthetic at the cost of increased risk of catheter-related complications like displacement and higher infection rate. Also, many practices lack the infrastructure to manage catheters. We are continuously exploring options to extend block duration without catheters, and local anesthetic additives offer a viable option to prolong the benefits of plain local anesthetics. Recent Findings A recent randomized cross-over study has suggested that the efficacy of local anesthetic additives like dexamethasone on the duration of nerve block remains uncertain despite several supporting systematic reviews and meta-analysis data. Summary This article reviews current literature to provide clinically relevant information about common nerve block additives, describing rationale for their use, effect on block onset, extension of block duration, and safety profiles of the additives.