Addition of dexmedetomidine prolongs duration of vasodilation induced by sympathetic block with mepivacaine in dogs

Dexmedetomidine as an Adjunct in a Fluoroscopically Guided Stellate Ganglion Block for Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by pain that is disproportionate to the inciting event. Autonomic and inflammatory responses predominate, and treatment plans that explicitly target these responses reduce symptoms for longer periods of time, are typically better tolerated, and have more favorable outcomes. Our patient was a young male who presented with a four-month history of a road traffic accident (RTA) that resulted in a fractured left distal radius and scaphoid. His main complaint was pain and discomfort, even after surgical forearm stabilization, as well as hyperesthesia, restricted range of motion, and new-onset tremors. The patient was provisionally diagnosed with complex regional pain syndrome (CRPS) and booked for a fluoroscopically guided stellate ganglion block when the oral medication regime provided minimal relief. A stellate ganglion block was administered using a combination of ropivacaine, methylprednisolone, and dexmedetomidine under fluoroscopic guidance. During our routine outpatient follow-ups, our patient's pain score on the visual analog scale (VAS) fell to zero, the burning, vasomotor, and temperature abnormalities subsided, and he gradually regained the use of his left forearm and hand. The etiology of complex regional pain syndrome is multifaceted. Early identification and therapy typically halt the progression. Long-term outcomes are improved by treatment strategies that target inflammatory and autonomic responses. Dexmedetomidine has a mild anti-nociceptive action when used as an adjuvant in peripheral nerve blocks and ganglion blocks, blocking pain transmission in Aδ and C fibers. We feel that by combining dexmedetomidine and a stellate ganglion block, we could provide immediate and long-term relief to our patient. More research is needed to monitor and analyze the efficacy of dexmedetomidine as a treatment for chronic pain syndromes such as CRPS.

Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries

Background

Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far.

Methods

The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 μg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 μg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours.

Results

The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51).

Conclusion

Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.¹.