bupivacaine + epinephrine + clonidine + dexamethasone

This multimodal analgesic combination, often referred to as a 'protracted mixture,' consists of the local anesthetic bupivacaine (Marcaine), the vasoconstrictor epinephrine (adrenaline), the alpha-2 adrenergic agonist clonidine, and the synthetic corticosteroid dexamethasone. It was specifically evaluated in a Phase 4 randomized clinical trial (Hobsali) conducted by Regionshospitalet Silkeborg for the management of postoperative pain following total knee arthroplasty. In this context, dexamethasone acts as a glucocorticoid adjuvant that prolongs the duration of sensory nerve blocks and reduces systemic inflammatory responses. The combination is administered via saphenous and obturator nerve blocks to provide extended analgesia, reduce postoperative opioid consumption, and minimize associated side effects such as nausea and vomiting.

Other names

dexamethasone-Regionshospitalet Silkeborg-postoperative painprotracted mixtureHobsali mixture