{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:00:21Z","timestamp":1792807221719,"version":"4.5.0"},"reference-count":63,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T00:00:00Z","timestamp":1610236800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["32003B_169974\/"],"award-info":[{"award-number":["32003B_169974\/"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["1"],"award-info":[{"award-number":["1"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Moderate\u2010to\u2010severe postoperative pain persists for longer than the duration of single\u2010shot peripheral nerve blocks and hence continues to be a problem even with the routine use of regional anaesthesia techniques. The administration of local anaesthetic adjuncts, defined as the concomitant intravenous or perineural injection of one or more pharmacological agents, is an attractive and technically simple strategy to potentially extend the benefits of peripheral nerve blockade beyond the conventional maximum of 8\u201314\u00a0hours. Historical local anaesthetic adjuncts include perineural adrenaline that has been demonstrated to increase the mean duration of analgesia by as little as just over 1 hour. Of the novel local anaesthetic adjuncts, dexmedetomidine and dexamethasone have best demonstrated the capacity to considerably improve the duration of blocks. Perineural dexmedetomidine and dexamethasone increase the mean duration of analgesia by up to 6\u00a0hour and 8\u00a0hour, respectively, when combined with long\u2010acting local anaesthetics. The evidence for the safety of these local anaesthetic adjuncts continues to accumulate, although the findings of a neurotoxic effect with perineural dexmedetomidine during in\u2010vitro studies are conflicting. Neither perineural dexmedetomidine nor dexamethasone fulfils all the criteria of the ideal local anaesthetic adjunct. Dexmedetomidine is limited by side\u2010effects such as bradycardia, hypotension and sedation, and dexamethasone slightly increases glycaemia. In view of the concerns related to localised nerve and muscle injury and the lack of consistent evidence for the superiority of the perineural vs. systemic route of administration, we recommend the off\u2010label use of systemic dexamethasone as a local anaesthetic adjunct in a dose of 0.1\u20130.2\u00a0mg.kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    for all patients undergoing surgery associated with significant postoperative pain.\n                  <\/jats:p>","DOI":"10.1111\/anae.15245","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T23:13:46Z","timestamp":1610666026000},"page":"100-109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":133,"title":["Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review"],"prefix":"10.1111","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-9407","authenticated-orcid":false,"given":"N.","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK"},{"name":"King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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