GasGasGas - Anaesthetic Science for Anaesthesia! Peri-Neural Local Anaesthetic Adjuncts for Regional Anaesthesia
Aug 29, 2025
Dive into the fascinating world of peri-neural local anaesthetic adjuncts! Discover the rationale behind extending block duration and learn about effective strategies like vasoconstrictors and modified-release formulations. Explore non-hypnotic options such as adrenaline and magnesium, alongside the effects of sodium bicarbonate and hyaluronidase. Find out about the innovative uses of ketamine and midazolam, and the benefits of opioid adjuncts like buprenorphine. The discussion wraps up with insights on liposomal bupivacaine and practical recommendations.
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Choose IV Dexamethasone Over Perineural
- Prefer IV dexamethasone for postoperative analgesia rather than perineural administration because systemic dosing is licensed.
- Use around 4 mg perineurally if chosen, since higher doses add little benefit.
Sodium Bicarbonate Speeds Onset
- Sodium bicarbonate raises pH to increase the fraction of unionized local anaesthetic and speed onset.
- This classic chemistry trick improves membrane penetration of the LA.
Hyaluronidase Improves Spread In Eye Blocks
- Hyaluronidase accelerates onset in ophthalmic blocks by degrading glycosaminoglycans and improving spread.
- Its utility is procedure‑specific rather than general perineural use.