Buprenorphine – the unique opioid adjuvant in regional anesthesia

ABSTRACT

Regional anesthesia techniques are commonly used for many surgical procedures alone or as an addition to general anesthesia, because they offer many advantages over general anesthesia. Unfortunately these techniques are partially limited by the time of action of local anesthetics. One of the methods of overcoming this limitation is adding to the local anesthetic solution additional drug – so called adjuvant. Among many adjuvants to local anesthetic drugs tested so far one seems to be particularly interesting – buprenorphine. The aim of this paper is to present pharmacological background for using buprenorphine for regional anesthesia and to review clinical trials of using buprenorphine for all regional anesthesia techniques: spinal and epidural anesthesia, peripheral nerves blocks, local anesthesia and intravenous regional anesthesia.

KEYWORDS:

• Buprenorphine
• regional anesthesia
• spinal anesthesia
• epidural anesthesia
• peripheral nerve block
• chronic pain syndrome

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Perineural local anesthesia is an important method of postoperative pain management.

• Opioids are valuable adjuvant to local anesthetics due to the prolongation of analgesic effect.

• Buprenorphine is the longest acting opioid and its perineural administration is well established in postoperative analgesia.

• Buprenorphine given perineurally acts on peripheral opioid receptors and Na-channels similarly to local anesthetics.

• The most useful regional anesthetic techniques suitable for adding buprenorphine as an adjuvant to local anesthetics are brachial plexus block, femoral nerve block, and sciatic nerve block.