Update on adjuvants in regional anesthesia

Abstract

Management of postoperative pain relieves suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. Pain control regimens should not be standardized; rather, they are tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to agents given. Nociception is the physiologic process of activation of neural pathways by stimuli that are potentially or currently damaging to tissue. Pain in contrast to nociception, is a conscious experience. Local anesthetics are drugs used to prevent or relieve pain in specific regions of the body. Currently used local anesthetics bind to voltage-gated Na+channels in peripheral nerves, block sodium movement through sodium channel, and thus block nerve conduction. Local anaesthetics may be toxic if sufficient amounts are absorbed into the systemic circulation. Of these bupivacaine

Intraoperative administration of epidural or intrathecal opioids for example reduces the need for systemic opioids postoperatively. For major abdominal surgeries with extensive incisions, epidural infusions with local anesthetic provide superior pain relief as compared with conventional parenteral narcotics.