A way to improve neuro regional analgesia: what adjuvant is the best? A narrative review.

Abstract

Introduction. The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics in order to determine adjuvant with the best effect among all others. More precisely the time of action onset, depth of the effect, duration of the block and some additional effects such as “marker of intravascular injection”, safety and toxicity profile, along with the adjuvant, which have all these properties in a sufficient degree. Materials and methods. We searched for information in Medline, PubMed, Scopus, Embase. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this article. Results. Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All them try to find to find “ideal” adjuvant, that have all needed effects at sufficient degree, but we think that due to the different groups that adjuvants belong to some adjuvants are better than another. Combination of adjuvants is not positive at all times. Conclusion. A variety of adjuvants to local anesthetics are available now, but yet data about most of them remains controversial, so more studies are required to found out best adjuvants and their adverse effects