Measures to prolong duration of sensory block after regional anaesthesia

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This review article discusses the evidence for the different techniques used to prolong sensory neural blockade. Of the commonly used adjuvants dexamethasone (perineural 4mg, followed by intravenous 0.1-0.2mg/kg) was the most effective adjuvant (4-8h prolongation), closely followed by dexmedetomidine (50-60mcg perineural or 1mcg/kg IV, (3-4.5h prolongation) and then clonidine (75-150 mcg perineurally, 3h prolongation). Catheter techniques while effective are more expensive, have more complications and can interfere with ERAS protocols, whilst liposomal bupivacaine has not met expectations.

Reviewed by Derek Rosen