Journal of Anesthesia

, Volume 33, Issue 1, pp 163–163 | Cite as

Adding dextran to local anesthetic enhances analgesia

  • Masahiko TsuchiyaEmail author
  • Koh Mizutani
  • Wasa Ueda
Letter to the Editor

To the Editor:

We read with interest the review by Tobe et al. regarding approaches to extend local anesthetics (LA) action [1]. 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 [2]. Also, LMWD added to LA induced long-term profound analgesia with lower LA systemic toxicity by reducing systemic LA absorption [3]. These effects were demonstrated in infiltration nerve block (NB) [2], transversus abdominis plane block [3], rectus sheath block [3], quadratus lumborum block [4], 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 [3]. We believe that LMWD is another promising agent to extend LA action.


Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.


  1. 1.
    Tobe M, Suto T, Saito S. The history and progress of local anesthesia: multiple approaches to elongate the action. J Anesth. 2018;32:632–6.CrossRefGoogle Scholar
  2. 2.
    Ueda W, Hirakawa M, Mori K. Inhibition of epinephrine absorption by dextran. Anesthesiology. 1985;62:72–5.CrossRefGoogle Scholar
  3. 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. 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

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyOsaka City University Graduate School of MedicineOsakaJapan
  2. 2.Department of AnesthesiaOsaka Rosai HospitalSakaiJapan
  3. 3.Department of Anesthesiology and Intensive Care MedicineKochi Medical SchoolKochiJapan

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