Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate (Review Article)

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Edinoﬀ Amber N.; Fitz Gerald Joseph S.; A.Holland Krisha Andrea; Reed Johnnie G.; Murnane Sarah E.; Minter Sarah G.; Kaye Aaron J.; Cornett Elyse M.; IMANI FARNAD; KHADEMI SEYED HOSSEIN; Kaye Adam M.; Urman Richard D.; Kaye Alan D.

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Journal: Anesthesiology and Pain Medicine Year:2021 | Volume:11 | Issue:3 Page(s): 0-0

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Title

Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate (Review Article)

Author(s)

Keywords

Peripheral Nerve Blocks

NMDA Antagonists

Adjuvants

Neostigmine

Bicarbonate

Epinephrine

Abstract

The potential for misuse, overdose, and chronic use has led researchers to look for other methods to decrease opioid consumption in patients with acute and chronic pain states. The use of Peripheral Nerve Blocks for surgery has gained increasing popularity as it minimizes peripheral pain signals from the nociceptors of local tissue sustaining trauma and inﬂ ammation from surgery. The individualization of Peripheral Nerve Blocks using adjuvant drugs has the potential to improve patient outcomes and reduce chronic pain. The major limitations of Peripheral Nerve Blocks are their limited duration of action and dose-dependent adverse eﬀ ects. Adjuvant drugs for Peripheral Nerve Blocks show increasing potential as a solution for postoperative and chronic pain with their synergistic eﬀ ects to increase the duration of action and decrease the required dosage of local anesthetic. N-methyl-d-aspartate (NMDA) receptor antagonists are a viable option for patients with opioid resistance and neuropathic pain due to their aﬃ nity to the neurotransmitter glutamate, which is released when patients experience a noxious stimulus. Neostigmine is a cholinesterase inhibitor that exerts its eﬀ ect by competitively binding at the active site of acetylcholinesterase, which prevents the hydrolysis of acetylcholine and subsequently retaining acetylcholine at the nerve terminal. Epinephrine, also known as adrenaline, can potentially be used as an adjuvant to accelerate and prolong analgesic eﬀ ects in digital nerve blocks. The theorized role of sodium Bicarbonate in local anesthetic preparations is to increase the pH of the anesthetic. The resulting alkaline solution enables the anesthetic to more readily exist in its un-ionized form, which more eﬃ ciently crosses lipid membranes of peripheral nerves. However, more research is needed to show the eﬃ cacy of these Adjuvants for nerve block prolongation as studies have been either mixed or have small sample sizes.

Cites

Investigating the expression of N-methyl-D-aspartate receptors and cognitive function in children with attention-deficit hyperactivity disorder: A comparative study

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APA: Copy

Edinoﬀ, Amber N., Fitz Gerald, Joseph S., A.Holland, Krisha Andrea, Reed, Johnnie G., Murnane, Sarah E., Minter, Sarah G., Kaye, Aaron J., Cornett, Elyse M., IMANI, FARNAD, KHADEMI, SEYED HOSSEIN, Kaye, Adam M., Urman, Richard D., & Kaye, Alan D.. (2021). Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate (Review Article). ANESTHESIOLOGY AND PAIN MEDICINE, 11(3), 0-0. SID. https://sid.ir/paper/670918/en

Vancouver: Copy

Edinoﬀ Amber N., Fitz Gerald Joseph S., A.Holland Krisha Andrea, Reed Johnnie G., Murnane Sarah E., Minter Sarah G., Kaye Aaron J., Cornett Elyse M., IMANI FARNAD, KHADEMI SEYED HOSSEIN, Kaye Adam M., Urman Richard D., Kaye Alan D.. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate (Review Article). ANESTHESIOLOGY AND PAIN MEDICINE[Internet]. 2021;11(3):0-0. Available from: https://sid.ir/paper/670918/en

IEEE: Copy

Amber N. Edinoﬀ, Joseph S. Fitz Gerald, Krisha Andrea A.Holland, Johnnie G. Reed, Sarah E. Murnane, Sarah G. Minter, Aaron J. Kaye, Elyse M. Cornett, FARNAD IMANI, SEYED HOSSEIN KHADEMI, Adam M. Kaye, Richard D. Urman, and Alan D. Kaye, “Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate (Review Article),” ANESTHESIOLOGY AND PAIN MEDICINE, vol. 11, no. 3, pp. 0–0, 2021, [Online]. Available: https://sid.ir/paper/670918/en

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