Advantages and disadvantages of adrenaline in regional anaesthesia

Adrenaline has been added to local anaesthetic solutions for more than a century. The aim has been to delay the absorption of the local anaesthetic drug and to prolong and enhance its anaesthetic effect, both in peripheral and central neuraxial blockades. The intention in this chapter has been to give up-to-date knowledge about adrenaline as an adjuvant to local anaesthetics and/or opioids in clinical peripheral and central blockades. My own research has focused on optimizing postoperative epidural analgesia by adding adrenaline and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine. The main part of this chapter will therefore focus on the advantages and disadvantages of adrenaline in epidural analgesia. However, recent knowledge about adrenaline in peripheral blockade will also be covered, together with some pharmaceutical comments on the shelf-life of local anaesthetic mixtures containing adrenaline.