Adding dextran to local anesthetic enhances analgesia
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To the Editor:
We read with interest the review by Tobe et al. regarding approaches to extend local anesthetics (LA) action . However, use of dextran as an LA adjuvant was not described.
Our previous studies showed that adding low-molecular weight dextran (LMWD) to LA and an adrenaline mixture reduced systemic adrenaline absorption, abrogating adverse hemodynamic effects . Also, LMWD added to LA induced long-term profound analgesia with lower LA systemic toxicity by reducing systemic LA absorption . These effects were demonstrated in infiltration nerve block (NB) , transversus abdominis plane block , rectus sheath block , quadratus lumborum block , and mandibular NB cases. Formation of an LMWD and LA complex that remains at the NB site longer may be the associated mechanism [3, 4].
Results of other studies are conflicting, as the NBs were performed with classical landmark methods. Our findings were obtained with an ultrasound-guided technique that enables accurate LA injection as a compartment NB around nerves or between fascias, which may be essential for the effects of LMWD . We believe that LMWD is another promising agent to extend LA action.
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Conflict of interest
There are no conflicts of interest to declare.
- 3.Hamada T, Tsuchiya M, Mizutani K. Takahashi R, Muguruma K, Maeda K, Ueda W, Nishikawa K. Levobupivacaine-dextran mixture for transversus abdominis plane block and rectus sheath block in patients undergoing laparoscopic colectomy: a randomised controlled trial. Anaesthesia. 2016;71:411–6.CrossRefGoogle Scholar
- 4.Tsuchiya M, Mizutani K, Ueda W. Large volume of low concentration of local anesthetic dissolved with low-molecular weight dextran as adjuvant for ultrasound-guided posterior quadratus lumborum block greatly enhances and extends analgesic effects. Minerva Anestesiol. 2018;84:876–8.Google Scholar