Shifts in the use of adjuncts for regional anesthesia, aligning practice with evidence: a comprehensive review

Abstract

In regional anesthesia, there has been an evolution in the development of adjuncts to evidence-based practice that improve patient outcomes. This intensive review aims to discuss the historical perspective of adjuncts, including how they came into play in the practice of anesthesia, and reduce complications by refining efficacy. The traditional adjuncts, opioids and alpha-2 adrenergic agonists, have been employed for many years to prolong analgesia/anesthetic time, but their use is associated with significant side effects like respiratory depression and bradycardia. Newer adjuncts such as liposomal bupivacaine and magnesium have the potential to provide long-acting alternatives with less systemic toxicity. Alternatively, the review in question provides a critical assessment of the treatment efficacy and safety profile of these agents, helping to elucidate how clinical practice patterns are evolving. This study further emphasizes the need for ensuring that anesthesia protocols are current and incorporate updated research to keep patient safety in mind, while minimizing potential side-effects and improving outcomes. Future directions include ongoing research on and optimization of anesthesia adjuncts, as well as instilling a collaborative mindset among healthcare providers to incorporate the most updated high-quality evidence in their clinical practice.

Keywords: Adjuncts; Alpha-2 adrenergic agonists; Anesthesia safety; Corticosteroids; Evidence-based practice; Liposomal bupivacaine, Magnesium; Opioids; Pain management; Regional anesthesia

Citation: Zahid MA, Kaleem A, Hassan A, Izhar MF, Ali P, Rehman MA. Shifts in the use of adjuncts for regional anesthesia, aligning practice with evidence: a comprehensive review. Anaesth. pain intensive care 2025;29(8):1007-1013. DOI: 10.35975/apic.v29i8.3023

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025