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The ease of practice and relative predictability of neuraxial anesthesia, coupled with its potential to provide multiple benefits to patients in the perioperative period has led to its widespread popularity. Nevertheless, concern of potential failed blocks and untoward effects still limits the acceptance of these techniques. Much effort has been put forth to minimize these undesirable events and optimize the patient experience. The addition of adjuvant medications to local anesthetic preparations has been one avenue pursued to attain these goals.

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As early as 1900, Matas1 was combining morphine and cocaine for subarachnoid injection. Morphine was added in an attempt to prolong the effects of cocaine and to provide sedation. It was not until the 1970s, after the demonstration of opiate receptors in the spinal cord, that neuraxial opioids again began to enter routine use as part of modern regional anesthesia. As the percentage of surgeries performed in the ambulatory setting increases, interest has shifted to finding adjuncts that will provide faster recovery without compromising anesthetic reliability. Many substances have been investigated for use in the subarachnoid and epidural space as an attempt to improve the way that we care for patients (Tables 8–1 and 8–2).

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Table 8-1. Commonly Recommended Volumes of 8.4% Sodium Bicarbonate for Alkalinization of Local Anesthetic Solutions
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Table 8-2. Adjuvants for Neuraxial Anesthesia

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