Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector70094510.17816/RA700945WPEOSIReviewsНаучные обзорыReview ArticleAdjuvants to local anesthetics: efficacy, safety, and limitationsАдъюванты к местным анестетикам: эффективность, безопасность и ограниченияhttps://orcid.org/0009-0005-4118-3696KrestovnikovaAnastasia G.КрестовниковаАнастасия Геннадьевна
Russian Federation
sereda993@yandex.ruhttps://orcid.org/0000-0002-6127-07986726-2571ZabolotskiiDmitry V.ЗаболотскийДмитрий Владиславович
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

zdv4330303@gmail.comhttps://orcid.org/0000-0002-3400-89896101-0578KoriachkinVictor A.КорячкинВиктор Анатольевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

vakoryachkin@mail.ruhttps://orcid.org/0000-0002-2537-01423619-2048SimutisIonas S.СимутисИонас Стасио
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

simutis@mail.ruYoshkarOla City HospitalЙошкар-Олинская городская клиническая больницаMari State UniversityМарийский государственный университетSt. Petersburg State Pediatric Medical UniversityСанкт-Петербургский государственный педиатрический медицинский университетH. Turner National Medical Research Center for Children’s Orthopedics and Trauma SurgeryНациональный медицинский исследовательский центр детской травматологии и ортопедии имени Г.И. ТурнераNorth-West District Scientific and Clinical Center named after L.G. SokolovСеверо-Западный окружной научно-клинический центр имени Л.Г. СоколоваMechnikov North-Western State Medical UniversityСеверо-Западный государственный медицинский университет имени И.И. Мечникова25022026090520262015151401202625022026Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://rjraap.com/1993-6508/article/view/700945

There are few options for prolonging the action of amide local anesthetics: an increase in dose and concentration is associated with a higher risk of neurotoxicity and systemic complications, whereas catheter-based techniques are resource-intensive and increase the risk of infection. No new local anesthetic molecules have been introduced since the development of levobupivacaine. Therefore, the use of adjuvants to local anesthetics is considered the most promising approach. A targeted search of publications in Russian and English was conducted in PubMed (MEDLINE) and eLibrary databases using the following keywords and their combinations: блокада периферического нерва / peripheral nerve block, местные анестетики / local anesthetics, адъювант / adjuvant, нейротоксичность / neurotoxicity, дексаметазон / dexamethasone, дексмедетомидин / dexmedetomidine. A total of 66 full-text clinical and experimental studies on perineural and/or systemic use of adjuvants in peripheral nerve and interfascial blocks were included in the analysis. The main groups of adjuvants identified were adrenergic receptor agonists, glucocorticoids, opioids, N-methyl-D-aspartate receptor antagonists magnesium salts, and benzodiazepines. A significant prolongation of sensory block and/or time to first analgesic request was demonstrated. Adverse effects were described, including hemodynamic instability associated with α2-agonists, hyperglycemia and possible delayed recovery of nerve function with dexamethasone, opioid-induced nausea and vomiting, hypermagnesemia, psychotomimetic effects of ketamine, and midazolam-related neurotoxicity. Particular attention is given to the phenomenon of rebound pain. Perineural and/or systemic administration of dexamethasone and dexmedetomidine, as well as their combination, appears to be the most justified and safe approach to prolonging block duration. However, all adjuvants except epinephrine are used perineurally off-label, which necessitates individualized risk–benefit assessment and further randomized studies, including evaluation of long-term neurotoxicity.

Возможности пролонгирования действия амидных местных анестетиков ограничены: увеличение дозы и концентрации сопровождается ростом нейротоксичности и системных осложнений, а катетерные техники требуют ресурсов и повышают риск инфекций. Новых молекул местных анестетиков не появлялось со времени внедрения левобупивакаина. Именно поэтому наиболее перспективным направлением считается использование адъювантов к местным анестетикам. Выполнен целенаправленный поиск публикаций на русском и английском языках в базах данных PubMed (MEDLINE) и eLibrary по ключевым словам и их комбинациям: блокада периферического нерва, местные анестетики, адъювант, нейротоксичность, дексаметазон, дексмедетомидин; peripheral nerve block, local anesthetics, adjuvant, neurotoxicity, dexamethasone, dexmedetomidine. Для анализа отобраны 66 полнотекстовых клинических и экспериментальных работ, посвящённых периневральному или системному применению адъювантов при периферических и межфасциальных блокадах. Выделены основные группы адъювантов: агонисты адренергических рецепторов, глюкокортикоиды, опиоиды, антагонисты NMDA-рецепторов и соли магния, бензодиазепины. Показано статистически значимое удлинение сенсорного блока и/или времени до первой просьбы об аналгезии. Описаны побочные эффекты: гемодинамическая нестабильность при применении α2-агонистов, гипергликемия и возможное замедление восстановления нервной функции на фоне дексаметазона, опиоидиндуцированная тошнота и рвота, гипермагниемия, психотомиметические эффекты кетамина, нейротоксичность мидазолама. Особое внимание уделено феномену «рикошетной» боли. Периневральное и/или системное применение дексаметазона и дексмедетомидина, а также их сочетание представляется наиболее безопасной и обоснованной схемой увеличения длительности блокады. Однако все адъюванты, за исключением адреналина, используются периневрально off-label, что требует индивидуальной оценки соотношения риск–польза и дальнейших рандомизированных исследований, включая оценку отдалённой нейротоксичности.

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