The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia: A systematic review with network meta-analysis of randomised trials
Authors' conclusion
The best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam.
Study context
- Population
- Patients receiving single-injection upper extremity peripheral nerve blocks with adjuvants injected perineurally
- Participants
- 17,391 patients · 242 RCTs
- Comparison
- Perineural adjuvants added to local anaesthetics vs physiological saline
- Outcome
- Ratio of means (ROM) of the duration of analgesia
Methodological detailsfrequentist network meta-analysis, random effects model
- Frequentist network meta-analysis
- Random effects model
Pooled result
As reported in the abstract
Duration of analgesia (ROM vs saline)
Each group vs salineROM (95% CI)
Dexamethasone
1.95(1.79–2.13)
Buprenorphine
1.83(1.51–2.24)
Butorphanol
1.84(1.41–2.39)
Potassium chloride
1.89(1.15–3.11)
Dexmedetomidine
1.70(1.59–1.81)
Sufentanil
1.70(1.27–2.29)
Ketorolac
1.68(1.24–2.27)
Midazolam
1.55(1.24–1.94)
Tramadol
1.52(1.32–1.75)
Nalbuphine
1.50(1.30–1.72)
Morphine
1.43(1.09–1.88)
Magnesium sulfate
1.42(1.20–1.67)
Clonidine
1.36(1.24–1.50)
Fentanyl
1.23(1.08–1.40)
Safety
- Overall side effect rates low with all adjuvants
Original publication
The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia: A systematic review with network meta-analysis of randomised trials. Eur J Anaesthesiol. Published 19 June 2023. doi:10.
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