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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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