Less is better: role of adjuvants.

This scoping review summarizes current evidence on adjuvants used in regional anaesthesia and peripheral nerve blocks, such as dexamethasone, alpha-2 agonists, buprenorphine, ketamine, and magnesium. Adding adjuvants can modify block characteristics and improve pain control while reducing the need for local anaesthetics or other analgesics. Progress has been made in understanding their mechanisms of action. In the last two years, publications on dexmedetomidine have increased, though interest in dexamethasone may decline due to only moderate evidence. Opioid adjuvants are also being studied more. All adjuvants show varying efficacy, but evidence for dexmedetomidine remains lower than for dexamethasone.

Study at a glance

Abstract

To update published data about adjuvants and examine their evolution in use over the last 2 years. This scoping review highlights current and updated published evidence on using adjuvants and future research directions.Regional techniques (including peripheral nerve blocks) have become relevant for pain relief and postoperative quality recovery. Examples of adjuvant drugs for regional techniques include dexamethasone, alpha-2 agonists, buprenorphine, ketamine, magnesium, and so on. Adding adjuvants we can modify the characteristics of the blocks. We have made significant progress in understanding the mechanism of action of specific adjuvants, and we made a summary. Considering the review above, it can be observed that there has been an increasing trend in recent years to publish articles on dexmedetomidine; however, interest in dexamethasone may wane because of the moderate evidence. It is interesting to note that there has been an increase in the number of studies involving the use of opioids as adjuvants. All adjuvants have shown different levels of efficacy.Understanding the role of adjuvants is crucial to better pain control, as well as using a less local anaesthetic or less analgesic drugs. Despite the increasing number of articles on dexmedetomidine, the evidence remains lower than that for dexamethasone.