Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review
The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examin...
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| description | The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants.
To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.
Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.
Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.
Buprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist. |
| doi_str_mv | 10.1371/journal.pone.0137312 |
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To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.
Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.
Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.
Buprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0137312</identifier><identifier>PMID: 26355598</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adjuvants ; Adjuvants, Anesthesia - pharmacology ; Analgesia ; Analgesics ; Anesthesia ; Anesthesiology ; Anesthetics ; Anesthetics, Local - pharmacology ; Anti-Inflammatory Agents - pharmacology ; Bibliographic data bases ; Buprenorphine ; Clinical trials ; Clonidine ; Complications and side effects ; Control methods ; Data processing ; Dexamethasone ; Dosage and administration ; Drug approval ; Epinephrine ; Fentanyl ; Humans ; Licensing, certification and accreditation ; Local anesthesia ; Local anesthetics ; Magnesium ; Management ; Medical research ; Medicine ; Meta-analysis ; Methods ; Morphine ; Nerve Block ; Neurotoxicity ; Pain management ; Pain perception ; Peripheral Nerves - drug effects ; Prolongation ; Qualitative Research ; Quality ; Randomization ; Reviews ; Side effects ; Studies ; Surgery ; Toxicity ; Tramadol</subject><ispartof>PloS one, 2015-09, Vol.10 (9), p.e0137312-e0137312</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Kirksey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Kirksey et al 2015 Kirksey et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-dd0e0347f96d0c371c62dda9431acbbbd0444a8b69ef157be772e1d5c3a6bfdf3</citedby><cites>FETCH-LOGICAL-c758t-dd0e0347f96d0c371c62dda9431acbbbd0444a8b69ef157be772e1d5c3a6bfdf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565585/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565585/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26355598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirksey, Meghan A</creatorcontrib><creatorcontrib>Haskins, Stephen C</creatorcontrib><creatorcontrib>Cheng, Jennifer</creatorcontrib><creatorcontrib>Liu, Spencer S</creatorcontrib><title>Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants.
To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.
Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.
Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.
Buprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.</description><subject>Adjuvants</subject><subject>Adjuvants, Anesthesia - pharmacology</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Anesthetics</subject><subject>Anesthetics, Local - pharmacology</subject><subject>Anti-Inflammatory Agents - pharmacology</subject><subject>Bibliographic data bases</subject><subject>Buprenorphine</subject><subject>Clinical trials</subject><subject>Clonidine</subject><subject>Complications and side effects</subject><subject>Control methods</subject><subject>Data processing</subject><subject>Dexamethasone</subject><subject>Dosage and administration</subject><subject>Drug approval</subject><subject>Epinephrine</subject><subject>Fentanyl</subject><subject>Humans</subject><subject>Licensing, certification and accreditation</subject><subject>Local anesthesia</subject><subject>Local anesthetics</subject><subject>Magnesium</subject><subject>Management</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Meta-analysis</subject><subject>Methods</subject><subject>Morphine</subject><subject>Nerve Block</subject><subject>Neurotoxicity</subject><subject>Pain management</subject><subject>Pain perception</subject><subject>Peripheral Nerves - drug effects</subject><subject>Prolongation</subject><subject>Qualitative Research</subject><subject>Quality</subject><subject>Randomization</subject><subject>Reviews</subject><subject>Side effects</subject><subject>Studies</subject><subject>Surgery</subject><subject>Toxicity</subject><subject>Tramadol</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99v0zAQxyMEYqPwHyCIhITgocWO4yTlAalM_Kg0sbEBr9bFPqcublzspLD_HnftpgbtAeUh1vlz3_vhuyR5SsmEspK-Wbret2Ana9fihEQTo9m95JhOWTYuMsLuH5yPkkchLAnhrCqKh8lRVjDO-bQ6TtanToJNZy2GboGdkek5erNeoI_WL-g3mL63Tv5MZ2rZb6DtQqqdT8-9s65toDOuTZ2O_mAbDAbeprP08ip0uIKt2NcerOniMepc4Mbg78fJAw024JP9f5R8__jh28nn8enZp_nJ7HQsS151Y6UIEpaXelooImO9ssiUgmnOKMi6rhXJ8xyqupiipryssSwzpIpLBkWtlWaj5PlOd21dEPtmBUFLyouyrLIyEvMdoRwsxdqbFfgr4cCIa4PzjQAfi7AolNK1jllozmVOCa1B8grygsTUONEQtd7to_X1CpXEtosNHIgOb1qzEI3biJwXnFc8CrzaC3j3q4-PIVYmSLQWWnT9dd6UszJGjOiLf9C7q9tTDcQCTKtdjCu3omKWZ1XGsmmcglEyuYOKn8KVkXGytIn2gcPrgUNkOvzTNdCHIOaXF__Pnv0Ysi8P2AWC7RbB2X47YGEI5jtQeheCR33bZErEdjFuuiG2iyH2ixHdnh0-0K3TzSawv2VSCi4</recordid><startdate>20150910</startdate><enddate>20150910</enddate><creator>Kirksey, Meghan A</creator><creator>Haskins, Stephen C</creator><creator>Cheng, Jennifer</creator><creator>Liu, Spencer S</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150910</creationdate><title>Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review</title><author>Kirksey, Meghan A ; Haskins, Stephen C ; Cheng, Jennifer ; Liu, Spencer S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-dd0e0347f96d0c371c62dda9431acbbbd0444a8b69ef157be772e1d5c3a6bfdf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adjuvants</topic><topic>Adjuvants, Anesthesia - pharmacology</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Anesthetics</topic><topic>Anesthetics, Local - pharmacology</topic><topic>Anti-Inflammatory Agents - pharmacology</topic><topic>Bibliographic data bases</topic><topic>Buprenorphine</topic><topic>Clinical trials</topic><topic>Clonidine</topic><topic>Complications and side effects</topic><topic>Control methods</topic><topic>Data processing</topic><topic>Dexamethasone</topic><topic>Dosage and administration</topic><topic>Drug approval</topic><topic>Epinephrine</topic><topic>Fentanyl</topic><topic>Humans</topic><topic>Licensing, certification and accreditation</topic><topic>Local anesthesia</topic><topic>Local anesthetics</topic><topic>Magnesium</topic><topic>Management</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Meta-analysis</topic><topic>Methods</topic><topic>Morphine</topic><topic>Nerve Block</topic><topic>Neurotoxicity</topic><topic>Pain management</topic><topic>Pain perception</topic><topic>Peripheral Nerves - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirksey, Meghan A</au><au>Haskins, Stephen C</au><au>Cheng, Jennifer</au><au>Liu, Spencer S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-09-10</date><risdate>2015</risdate><volume>10</volume><issue>9</issue><spage>e0137312</spage><epage>e0137312</epage><pages>e0137312-e0137312</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants.
To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.
Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.
Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.
Buprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26355598</pmid><doi>10.1371/journal.pone.0137312</doi><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| subjects | Adjuvants Adjuvants, Anesthesia - pharmacology Analgesia Analgesics Anesthesia Anesthesiology Anesthetics Anesthetics, Local - pharmacology Anti-Inflammatory Agents - pharmacology Bibliographic data bases Buprenorphine Clinical trials Clonidine Complications and side effects Control methods Data processing Dexamethasone Dosage and administration Drug approval Epinephrine Fentanyl Humans Licensing, certification and accreditation Local anesthesia Local anesthetics Magnesium Management Medical research Medicine Meta-analysis Methods Morphine Nerve Block Neurotoxicity Pain management Pain perception Peripheral Nerves - drug effects Prolongation Qualitative Research Quality Randomization Reviews Side effects Studies Surgery Toxicity Tramadol |
| title | Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T05%3A49%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Local%20Anesthetic%20Peripheral%20Nerve%20Block%20Adjuvants%20for%20Prolongation%20of%20Analgesia:%20A%20Systematic%20Qualitative%20Review&rft.jtitle=PloS%20one&rft.au=Kirksey,%20Meghan%20A&rft.date=2015-09-10&rft.volume=10&rft.issue=9&rft.spage=e0137312&rft.epage=e0137312&rft.pages=e0137312-e0137312&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0137312&rft_dat=%3Cgale_plos_%3EA428232926%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1715677827&rft_id=info:pmid/26355598&rft_galeid=A428232926&rft_doaj_id=oai_doaj_org_article_ddfbfc37f55c4101bac58a4600c350fa&rfr_iscdi=true |