Analgesic adjuvants for brachial plexus block - A narrative review

Abstract

Ultrasound guided brachial plexus block is gaining importance as it provides excellent surgical anaesthesia, nonsurgical analgesia, immobilisation of limb and reduces general anaesthesia related side effects. The technique also has the advantage of visualisation of needle towards the nerve of interest and deposition of drug with immediate anaesthesia and patient satisfaction thereby decreasing the chances of vascular injury. Local anaesthetics when given in large doses can cause systemic toxicity whereas when given as single shot or in smaller dose fail to either produce desired effect or duration of action exposing the patient to the pain of surgical trauma. To overcome this, various class of drugs have been used as adjuvants to local anaesthetics and their efficacy are studied through the quality of block produced, known as analgesic adjuvants. In this review, we aim to discuss a few studies regarding the use of various adjuvants for brachial plexus block and provide current evidence for use and also summarizes the best strategies for optimizing pain control and reducing adverse effects after surgery under brachial plexus block.