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Sinha J, Pokhriyal AS, Asthana V, Nautiyal R. Dexmedetomidine vs Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomies. Anesth Pain Med 2023; 13:e142059. [PMID: 38666229 PMCID: PMC11041814 DOI: 10.5812/aapm-142059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 04/28/2024] Open
Abstract
Background In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain. Objectives This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients. Methods A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction. Results When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment. Conclusions The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.
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Affiliation(s)
- Jyoti Sinha
- Department of Anesthesiology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
| | | | - Veena Asthana
- Department of Anesthesiology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
| | - Ruchira Nautiyal
- Department of Gynecology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
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Schubert AK, Seneviratne V, Stolz J, Wiesmann T, Wulf H, Eberhart L, Dinges HC. The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia: A systematic review with network meta-analysis of randomised trials. Eur J Anaesthesiol 2023; 40:672-690. [PMID: 37337656 DOI: 10.1097/eja.0000000000001860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Peripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing. OBJECTIVE The objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks. DESIGN A systematic review of randomised controlled trials with network meta-analyses. DATA SOURCES A literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023. ELIGIBILITY CRITERIA Randomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia. RESULTS The review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants. CONCLUSION The best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias. TRIAL REGISTRATION PROSPERO 2018 CRD42018115722.
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Affiliation(s)
- Ann-Kristin Schubert
- From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg (A-KS, VS, JS, TW, HW, LE, H-CD), and the Department of Anaesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum Schwäbisch-Hall, Schwäbisch-Hall, Germany (TW)
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Shi W, Dong J, Chen J, Yu H. A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery. Int Wound J 2022; 20:1476-1490. [PMID: 36330591 PMCID: PMC10088860 DOI: 10.1111/iwj.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper-limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta-analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper-limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side-effects. There is moderate-quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper-limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety-profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine-related neurological safety in future studies.
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Affiliation(s)
- Wei Shi
- Department of Anesthesiology, West China Hospital Sichuan University Chengdu China
| | - Jing Dong
- Hospital of Chengdu University of Traditional Chinese Medicine Chengdu China
| | - Jian‐Feng Chen
- Department of Anesthesiology, West China Hospital Sichuan University Chengdu China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital Sichuan University Chengdu China
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Moges K, Tadesse Y, Fentie F. The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study. SAGE Open Med 2022; 10:20503121221126687. [PMID: 36267495 PMCID: PMC9577080 DOI: 10.1177/20503121221126687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To compare the postoperative analgesia efficacy of dexamethasone added to low-dose high-volume bupivacaine in ultrasound-guided supraclavicular brachial plexus block for adult patients who underwent upper limb orthopedic surgeries at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Methods An observational prospective cohort study was conducted from 1 September 2021 to 30 January 2022. Using a systematic random sampling technique, 56 patients (equal groups of 28 patients) aged 18-60 years scheduled for elective upper limb orthopedic surgeries under supraclavicular block were recruited. According to the discretion of anesthetists' management plan of supraclavicular block, those patients who received 38 mL of 0.25% bupivacaine with 2 mL (8 mg) dexamethasone as the case group (DB) while those patients who received 40 mL of 0.25% bupivacaine alone as the cohort group (B). Time to first analgesic request, onset of sensory and motor, and motor block duration were analyzed with Student's t-test whereas pain severity and analgesic consumption were assessed using the Mann-Whitney U test. Categorical variables were analyzed using chi-square test. p-value less than 0.05 considered statistically significant. Results Postoperative analgesia had significantly prolonged in the dexamethasone bupivacaine group with a mean duration of 1098.00 ± 195.90 min compared to 464.29 ± 113.75 min in the bupivacaine alone group, p-value < 0.001. Moreover, the dexamethasone bupivacaine group significantly consumed less total tramadol and diclofenac than bupivacaine alone, with a median dose of 0 (0-50) versus 50 (21.25-78.75) mg and 40 (0-50) versus 65 (47.50-77.50) mg, respectively. The median visual analogue scale scores were significantly reduced at 6th, 8th, 12th, and 24th hour in the dexamethasone bupivacaine group. Conclusion Dexamethasone added to low-dose high-volume of bupivacaine in supraclavicular brachial plexus block significantly prolonged the duration of analgesia.
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Affiliation(s)
- Kassaw Moges
- Department of Anesthesia, Bahir Dar
University, Bahir Dar, Ethiopia,Kassaw Moges, Department of Anesthesia,
Bahir Dar University, PO BOX: 079, Bahir Dar 6040, Ethiopia.
| | - Yilkal Tadesse
- Department of Anesthesia, Bahir Dar
University, Bahir Dar, Ethiopia
| | - Fisiha Fentie
- Department of Anesthesia, Addis Ababa
University, Addis Ababa, Ethiopia
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Li M, Zhang P, Wei D. Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7996754. [PMID: 35273646 PMCID: PMC8904098 DOI: 10.1155/2022/7996754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
Background Both dexamethasone and dexmedetomidine are commonly used local anaesthetic adjuvants in brachial plexus block to enhance the blocking effect. However, it is unclear which of the two drugs is more effective in a brachial plexus block. This article compares the effects of dexamethasone and dexmedetomidine combined with local anaesthetics in brachial plexus block through meta-analysis, availing information for current practice and future research. Methods We conducted a search of the PubMed, Embase, Cochrane Library, and Web of Science databases to identify studies investigating the effects of dexamethasone and dexmedetomidine combined with local anaesthetics on brachial plexus block. The databases were searched from their inception to October 2021. Clinical randomized controlled trials were included. Two researchers independently conducted literature screening. The Cochrane System Review Manual was adopted for literature quality evaluation, whereas Stata 14.0 software aided in the meta-analysis. The duration of analgesia was the primary outcome indicator; whereas, the secondary outcome indicators included the duration of sensory block and motor block. Results Seven articles were analysed, including 465 patients. Compared to the dexmedetomidine group, the dexamethasone group exhibited longer durations of analgesia (WMD = 111.29, 95% CI: 16.49-206.10, P = 0.021), sensory block (WMD = 173.20, 95% CI: 86.69-259.71, P < 0.0001), and motor block (WMD = 121.03, 95% CI: 12.87-229.20, P = 0.028). Conclusion The present meta-analysis results affirm that dexamethasone is a better local anaesthetic adjuvant in brachial plexus block that enhances the blocking effect. Nevertheless, the existing heterogeneity warrants additional large-scale, multicentre, high-quality randomized controlled trials in the future for further verification and to provide more reliable clinical evidence.
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Affiliation(s)
- Ming Li
- Department of Pharmacy, Affiliated Hospital of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Pinghu Zhang
- Department of Pharmacy, Yangzhou University Medical College, Yangzhou 225009, Jiangsu Province, China
| | - Duangao Wei
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu province, China
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Cai H, Fan X, Feng P, Wang X, Xie Y. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials. BMC Anesthesiol 2021; 21:233. [PMID: 34583650 PMCID: PMC8477554 DOI: 10.1186/s12871-021-01452-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives Peripheral injection of dexmedetomidine (DEX) has been widely used in regional anesthesia to prolong the duration of analgesia. However, the optimal perineural dose of DEX is still uncertain. It is important to elucidate this characteristic because DEX may cause dose-dependent complications. The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery. Method A search strategy was created to identify suitable randomized clinical trials (RCTs) in Embase, PubMed and The Cochrane Library from inception date to Jan, 2021. All adult patients undergoing upper limb surgery under BPB were eligible. The RCTs comparing DEX as an adjuvant to local anesthetic (LA) with LA alone for BPB were included. The primary outcome was duration of analgesia for perineural DEX. Secondary outcomes included visual analog scale (VAS) in 12 and 24 h, consumption of analgesics in 24 h, and adverse events. Results Fifty-seven RCTs, including 3332 patients, were identified. The subgroup analyses and regression analyses revealed that perineural DEX dose of 30-50 μg is an appropriate dosage. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of analgesia duration with less than and more than 60 μg doses was 220.31 (153.13–287.48) minutes and 68.01 (36.37–99.66) minutes, respectively. With long-acting LAs, the mean differences (95% CI) with less than and more than 60 μg doses were 332.45 (288.43–376.48) minutes and 284.85 (220.31–349.39) minutes. Conclusion 30-50 μg DEX as adjuvant can provides a longer analgesic time compared to LA alone and it did not increase the risk of bradycardia and hypotension. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01452-0.
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Affiliation(s)
- Hai Cai
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Xing Fan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Pengjiu Feng
- Department of Anesthesiology, Liuzhou Hospital of Traditional Chinese Medicine, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xiaogang Wang
- Department of Anesthesiology, Liuzhou Hospital of Traditional Chinese Medicine, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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Xiong C, Han CP, Zhao D, Tang ZH, Zhang YF, Wang J. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27064. [PMID: 34449500 PMCID: PMC10545042 DOI: 10.1097/md.0000000000027064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dexmedetomidine (Dexm), a selective alpha-2 adrenoceptor agonist, and dexamethasone (Dexa), a very potent and highly selective glucocorticoid, have both been proven effectively to prolong the duration of local anesthetics (LA) in regional anesthesia. However, data comparing the efficacy of Dexm and Dexa as perineural adjuvants are inconsistent. Therefore, this systematic review and meta-analysis of randomized and quasi-randomized controlled trials (RCTs) was conducted to compare the effects of Dexm and Dexa when used as LA adjuvants on peripheral nerve block (PNB). METHODS We systematically searched PubMed, Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up to October, 2020. The primary outcome was the duration of analgesia. Secondary outcomes included incidence of rescue analgesia, cumulative opioid consumption, time required for onset of sensory and motor blockades, duration of sensory and motor blockades, incidence of postoperative nausea and vomiting (PONV), and side effect-associated outcomes (e.g., bradycardia, sedation, hypotension, rates of infection, and neurological complications). The study was registered on PROSPERO, number CRD42020188796. RESULTS After screening of full-text relevant articles, 13 RCTs that met the inclusion criteria were retrieved for this systematic review. It was revealed that perineural Dexm provided equivalent analgesic duration to perineural Dexa. Besides, the intake of Dexm increased the incidence of rescue analgesia in limbs surgery, as well as the cumulative opioid consumption, and decreased the time required for onset of sensory and motor blockades for long-acting LA (all P < .05). Other analysis revealed insignificant difference between the 2 groups in terms of the incidence of PONV (P > .05). Additionally, 2 studies demonstrated that Dexm possesses more sedative properties than Dexa (P < .05). CONCLUSIONS This meta-analysis indicated that the analgesic duration of Dexm and Dexa as LA adjuvants in PNB is the same. Meanwhile, the effects of perineural Dexm and Dexa on some secondary outcomes, including the incidence of rescue analgesia, cumulative opioid consumption, and time required for onset of sensory and motor blockades, are associated with the surgical site and type of LA.
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Affiliation(s)
- Chang Xiong
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Cheng-peng Han
- Department of Rehabilitation, Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang, China
| | - Dong Zhao
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Zhi-hao Tang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yu-fan Zhang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Jian Wang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
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Mansour RF, Abdelghany MS. Ultrasound-guided suprazygomatic maxillary nerve block in cleft palate surgery: The efficacy of adding dexmedetomidine to bupivacaine. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1953832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Radwa Fathy Mansour
- Lecturer of Anesthesia and Surgical Intensive Care, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
| | - Mohamed Shebl Abdelghany
- Lecturer of Anesthesia and Surgical Intensive Care, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
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Comparison of postoperative analgesic effects in response to either dexamethasone or dexmedetomidine as local anesthetic adjuvants: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2021; 35:270-287. [PMID: 33515302 PMCID: PMC7969577 DOI: 10.1007/s00540-021-02895-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/08/2021] [Indexed: 11/03/2022]
Abstract
This review compares the effects of peripheral dexamethasone and dexmedetomidine on postoperative analgesia. We included six randomized controlled trials (354 patients) through a systematic literature search. We found that analgesia duration was comparable between dexamethasone and dexmedetomidine (58.59 min, 95% CI (confidence interval), - 66.13, 183.31 min) with extreme heterogeneity. Secondary outcome was also compared and no significant difference was observed in sensory block onset and duration and motor block duration and also for postoperative nausea and vomiting. It is noteworthy that dexamethasone reduced analgesic consumption (fentanyl) by 29.12 mcg compared with dexmedetomidine. We performed subgroup analyses and found no significant difference between the following: (1) lidocaine vs ropivacaine (P = 0.28), (2) nerve block vs nerve block + general anesthesia (P = 0.47), and (3) upper limb surgery vs thoracoscopic pneumonectomy (P = 0.27). We applied trial sequential analysis to assess the risks of type I and II errors and concluded that the meta-analysis was insufficiently powered to answer the clinical question, and further analysis is needed to establish which adjuvant is better. In conclusion, we believe that existing research indicates that dexamethasone and dexmedetomidine have equivalent analgesic effects in peripheral nerve blocks.
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Chazapi A, Lepetsos P, Gambopoulou Z, Siafaka I, Argyra E, Vadalouka A. Analgesic Effect of the Topical Use of Dexamethasone in Ultrasound-Guided Axillary Brachial Plexus Blockade: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Cureus 2021; 13:e12971. [PMID: 33654632 PMCID: PMC7913892 DOI: 10.7759/cureus.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Increasing the duration of regional anesthesia in orthopedic surgery is of vital importance, as it prolongs postoperative analgesia, allowing faster rehabilitation of patients. Dexamethasone has been found to extend the block duration in animal and human studies. The aim of this study is the assessment of the effect of the addition of dexamethasone to ropivacaine on the onset and duration of axillary brachial plexus block, along with the intensity of postoperative pain. Methods Forty patients undergoing below-elbow surgery under ultrasound-guided axillary brachial plexus block were randomly allocated to receive either 30 mL ropivacaine 0.75% with 2 mL of saline (Group A, n = 20) or 30 mL ropivacaine 0.75% with 2 mL of dexamethasone (4 mg) (Group B, n = 20). Sensory and motor blockade were assessed, with the use of the pinprick test and the modified Bromage scale, at five, 10, 15, and 20 min after the block. The duration of analgesia, intensity of postoperative pain, postoperative opioid consumption, overall satisfaction, and perioperative complications were compared between the two groups. Results We found no difference at the mean onset time of the sensory and motor block between the two groups. The mean duration of postoperative analgesia was three hours higher in the dexamethasone group (15.85 ± 4.82 versus 11.75 ± 6.81, p-value = 0.035). Pain intensity was lower in the dexamethasone group, at six and 12 hours after surgery (3.45 ± 1.79 versus 4.65 ± 1.79, p-value = 0.040). Postoperative opioid consumption, patient overall satisfaction, and perioperative complications were not significantly different between groups. Conclusions Dexamethasone prolongs the duration of ropivacaine in an axillary brachial plexus block and decreases postoperative pain in patients subjected to below-elbow surgery.
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Affiliation(s)
| | | | | | - Ioanna Siafaka
- 1st Department of Anaesthesiology, University of Athens Medical School, Athens, GRC
| | - Erifylli Argyra
- 1st Department of Anaesthesiology, University of Athens Medical School, Athens, GRC
| | - Athina Vadalouka
- 1st Department of Anaesthesiology, University of Athens Medical School, Athens, GRC
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Urits I, Virgen CG, Alattar H, Jung JW, Berger AA, Kassem H, Shehata IM, Elhassan A, Kaye AD, Viswanath O. A Comprehensive Review and Update of the Use of Dexmedetomidine for Regional Blocks. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:121-141. [PMID: 33633422 PMCID: PMC7901136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE OF REVIEW This evidence-based systematic review will focus on the use of dexmedetomidine and its role as adjuvant anesthetics in regional blocks to help better guide physicians in their practice. This review will cover background and mechanism of dexmedetomidine as well as the use in various regional blocks. RECENT FINDINGS Local anesthetics are preferred for nerve blocks over opioids; however, both due come with its own side effects. Local anesthetics may be toxic as they disrupt cell membrane and proteins, but by using adjuvants such as dexmedetomidine, that can prolong sensory and motor blocks can reduce total amount of local anesthetics needed. Dexmedetomidine is an alpha-2-adrenergic agonist used as additive for regional nerve block. It has a relatively low side effect profile and have been researched in various regional blocks (intrathecal, paravertebral, axillary, infraclavicular brachial plexus, interscalene). Dexmedetomidine shows promising results as adjuvant anesthetics in most regional blocks. SUMMARY Many studies have been done and many show promising results for the use of dexmedetomidine in regional blocks. It may significantly increase in duration of sensory and motor blocks that correlates with lower pain scores and less need of morphine in various regional blocks.
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Affiliation(s)
- Ivan Urits
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Celina Guadalupe Virgen
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Hamed Alattar
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Jai Won Jung
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Amnon A Berger
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Hisham Kassem
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Islam Mohammad Shehata
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Amir Elhassan
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Alan D Kaye
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Omar Viswanath
- Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Virgen, BS, Alattar, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Jung, BS, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Shehata, MD, Ain Shams University, Department of Anesthesiology, Cairo, Egypt. Elhassan, MD, Desert Regional Medical Center, Department of Anesthesiology, Palm Springs, CA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
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B Sumalatha G, D Ravichandra R. Dexmedetomidine as an adjuvant to infraorbital block in children undergoing cleft lip surgery – A clinical comparative study. ACTA ACUST UNITED AC 2020. [DOI: 10.18231/j.ijca.2020.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Regional nerve blocks provide excellent analgesia in children without adverse effects. However the duration of analgesia may be limited therefore addition of adjuvants can effectively prolong the duration of analgesia. Since alpha 2 agonist effectively prolong the duration of analgesia, we conducted a randomised double blind study to evaluate the effectiveness of dexmedetomidine as an adjuvant in infraorbital nerve block.: Eighty children of ASA grade 1 and 2, of either sex scheduled for cleft lip repair under general anaesthesia were allocated randomly into one of two equal groups (Group B and Group D, n=40). In both group sinfraorbital nerve block was performed with 1ml of solution on each side. The B group received bupivacaine 0.25% and the D group received b upivacaine 0.25% with 0.5µg/kg dexmedetomidine. The mean duration of analgesia and number of patients receiving rescue analgesia was recorded in both groups. The intraoperative hemodynamic parameters and postoperative sedation scores were recorded. For pain and sedation scores, Mann–Whitney U-test was used. Fisher’s exact test was used for comparison of categorical data. P ≤ 0.05 was considered as the level of statistical significance. Both groups were comparable in demographic profile. The mean duration of analgesia in Group D (733±49.15 minutes) was significantly longer compared to Group B (496±28.26) (p=0.001). There was a statistically significant difference in the number of patients receiving rescue analgesics in Group B (36) and Group D(8). The number of times of rescue analgesics in Group B and Group D was 3and 1 respectively, which was statistically significant. The intraoperative and postoperative hemodynamic HR was comparable in both groups (). The sedation score in the postoperative period did not differ between the two groups.
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Choi YM, Choi EJ, Ri HS, Park JY, You JA, Byeon GJ. The effect of dexmedetomidine and midazolam on combined spinal-epidural anesthesia in patients undergoing total knee arthroplasty. Anesth Pain Med (Seoul) 2020; 15:111-119. [PMID: 33329799 PMCID: PMC7713863 DOI: 10.17085/apm.2020.15.1.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/30/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background Intravenous dexmedetomidine has been reported to potentiate the anesthetic effect of local anesthetics and improve the quality of postoperative analgesia when used as an adjuvant in neuraxial block. We compared the effects of intravenous dexmedetomidine and midazolam for sedation on combined spinal-epidural (CSE) anesthesia. Methods This study included 50 patients undergoing total knee arthroplasty. CSE anesthesia was given using 10 mg bupivacaine for all patients. After checking the maximum sensory and motor levels, the patients were randomly allocated into two groups of 25 each to receive intravenous continuous infusion of dexmedetomidine (Group D) or midazolam (Group M) for sedation during surgery. Regression block level, hemodynamic changes, and sedation score were compared between the groups when the patients entered the postanesthetic care unit (PACU). For patient-controlled epidural analgesia, 0.2% levobupivacaine with 650 µg of fentanyl (150 ml in total) was infused at a rate of 1 ml/h, in addition to a 3-ml bolus dose with a 30-min lockout time. The visual analogue scale scores, additional analgesic demand, patient satisfaction, and adverse events between the two groups were also compared postoperatively. Results A significant difference was observed in relation to the sensory block level in the PACU (Group D: 6.3 ± 2.1; Group M: 3.2 ± 1.9) (P = 0.002). The motor block level and other outcomes showed no significant intergroup differences. Conclusions Intravenous injection of dexmedetomidine, rather than midazolam, for procedural sedation is associated with prolonged sensory block, with comparable incidences of adverse events during CSE anesthesia.
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Affiliation(s)
- Yun-Mi Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eun-Ji Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Su Ri
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju Yeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jun-A You
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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14
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Mostafa MF, Aal FAA, Ali IH, Ibrahim AK, Herdan R. Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study. Korean J Pain 2020; 33:81-89. [PMID: 31888322 PMCID: PMC6944365 DOI: 10.3344/kjp.2020.33.1.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. Methods Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 µg/kg dexmedetomidine (maximum volume 4 mL/side). Results The modified children's hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. Conclusions Addition of dexmedetomidine 0.5 µg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.
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Affiliation(s)
- Mohamed F Mostafa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma A Abdel Aal
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ibrahim Hassan Ali
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ibrahim
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ragaa Herdan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
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15
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Kang SH, Sim WS, Park HJ, Moon JY, Seon HJ, Lee JY. Efficacy of adjuvant dexmedetomidine in supraclavicular brachial plexus block for intractable complex regional pain syndrome: A case report with a 3-year follow-up. J Clin Pharm Ther 2019; 45:365-367. [PMID: 31599030 DOI: 10.1111/jcpt.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pain management for complex regional pain syndrome (CRPS) is challenging. When added to local anaesthetics, dexmedetomidine prolongs the duration of the block and improves analgesia. The effect of long-term dexmedetomidine use in the brachial plexus block (BPB) for CRPS is unknown. CASE DESCRIPTION Here, we describe a case of satisfactory pain relief after supraclavicular BPB with dexmedetomidine every 1-3 months over 2 years (10 treatments), in a patient with severe upper extremity CRPS-related pain. WHAT IS NEW AND CONCLUSION Repeated, long-term, perineural administration of dexmedetomidine with BPB may be suitable for alleviating refractory CRPS pain.
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Affiliation(s)
- Se Hee Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Yeon Moon
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heui Jin Seon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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16
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Comparing Postoperative Analgesic Effect of Dexmedetomidine or Dexamethasone Added to Lidocaine Through Infraclavicular Block in Forearm Surgery. Clin J Pain 2019; 35:766-771. [DOI: 10.1097/ajp.0000000000000736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aliste J, Layera S, Bravo D, Fernández D, Jara Á, García A, Finlayson RJ, Tran DQ. Randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound-guided infraclavicular block. Reg Anesth Pain Med 2019; 44:rapm-2019-100680. [PMID: 31300595 DOI: 10.1136/rapm-2019-100680] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND This randomized trial compared perineural dexamethasone (5 mg) and dexmedetomidine (100 µg) for ultrasound-guided infraclavicular brachial plexus block. We hypothesized that both adjuvants would result in similar durations of motor block and therefore designed the study as an equivalence trial (equivalence margin=3.0 hours). METHODS One hundred and twenty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (5 mg) or dexmedetomidine (100 µg). Patients and operators were blinded to the nature of the perineural adjuvant. After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Heart rate and blood pressure were recorded before the block as well as during the first 2 hours after its performance. Furthermore, the level of sedation (using the Ramsay Sedation Scale) was recorded in the postanesthesia care unit. Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. RESULTS No intergroup differences were observed in terms of success rate and surgical anesthesia. Compared with dexmedetomidine, dexamethasone provided longer durations of motor block (17.4 (4.0) vs 14.3 (3.0) hours; p<0.001; 95% CI 1.7 to 4.5), sensory block (19.0 (4.0) vs 15.0 (3.2) hours; p<0.001; 95% CI 2.6 to 5.4), and analgesia (22.2 (3.6) vs 16.9 (3.9) hours; p<0.001; 95% CI 3.7 to 6.9). Dexmedetomidine resulted in lower heart rate and blood pressure after the performance of the block, as well as an increased level of sedation postoperatively. CONCLUSION Compared with dexmedetomidine (100 µg), dexamethasone (5 mg) results in longer sensorimotor block and analgesic durations, as well as a decreased level of patient sedation. Further studies are required to compare dexamethasone and dexmedetomidine using different doses, local anesthetic agents, and approaches to the brachial plexus. TRIAL REGISTRATION NUMBER NCT03610893.
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Affiliation(s)
- Julián Aliste
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Sebastián Layera
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Daniela Bravo
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Diego Fernández
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Álvaro Jara
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Armando García
- Orthopedic Surgery, University of Chile, Santiago, Chile
| | | | - De Q Tran
- Anesthesiology, McGill University, Montreal, Quebec, Canada
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Soni S, Parmar K, Charan SM, Sethi S, Naik NB. Peritubal Infiltration of Fentanyl Compared to Dexmedetomidine with Ropivacaine in Percutaneous Nephrolithotomy: A Randomized Comparative Analysis. Anesth Essays Res 2019; 13:1-6. [PMID: 31031471 PMCID: PMC6444944 DOI: 10.4103/aer.aer_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL). Aims: The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL. Settings and Design: This was a prospective, randomized, double-blind, tertiary care center-based study. Subjects and Methods: A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl (n = 30) and Group RD ropivacaine and dexmedetomidine (n = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O’clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0–10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted. Statistical Analysis Used: Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas t-test and Mann–Whitney U-test were used to compare continuous variables between two groups. Results: Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD. Conclusions: Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.
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Affiliation(s)
- Sumit Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | | | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Naveen B Naik
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Albrecht E, Vorobeichik L, Jacot-Guillarmod A, Fournier N, Abdallah FW. Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block. Anesth Analg 2019; 128:543-554. [DOI: 10.1213/ane.0000000000003860] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Clement JC, Besch G, Puyraveau M, Grelet T, Ferreira D, Vettoretti L, Pili-Floury S, Samain E, Berthier F. Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial. Reg Anesth Pain Med 2019; 44:rapm-2018-100035. [DOI: 10.1136/rapm-2018-100035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 11/04/2022]
Abstract
Background and objectivesThe effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery.MethodsIn this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications.ResultsAmong the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, p<0.0004). Motor and sensory recovery occurred significantly later, and total analgesic consumption was lower in the Dexa than in the Control group. No nerve complication related to intravenous dexamethasone injection was recorded.ConclusionsThis study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block.Trial registration numberNCT02862327
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Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12573. [PMID: 30313043 PMCID: PMC6203584 DOI: 10.1097/md.0000000000012573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB). METHODS A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers. RESULTS Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], -3.86 minutes, 95% CI -5.45 to -2.27 minutes; I = 85%) and motor (MD, -5.21 minutes; 95% CI -7.48 to -2.94 minutes; I = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87-269.52 minutes; I = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48-230.91 minutes; I = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84-377.24 minutes; I = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI -0.02 to 0.05, I = 45%; P = .45) and hypotension (RD, 0.01, 95% CI -0.01 to 0.03, I = 0%; P = .57) between 2 groups. CONCLUSION Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.
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Affiliation(s)
- Wei Dai
- Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Maocai Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kaihua He
- Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University
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Akhondzadeh R, Rashidi M, Gousheh M, Olapour A, Baniahmad A. The Effect of Adding Dexmedetomidine as an Adjuvant to Lidocaine in Forearm Fracture Surgeries by Supraclavicular Block Procedure Under Ultrasound-Guided. Anesth Pain Med 2018; 8:e74355. [PMID: 30250821 PMCID: PMC6139532 DOI: 10.5812/aapm.74355] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/14/2018] [Accepted: 07/15/2018] [Indexed: 02/07/2023] Open
Abstract
Background To improve the brachial plexus block (BPB) performance, different compounds have been used as adjuvants to local analgesics. Objectives The aim of the present study was to investigate the effects of adding DEX to lidocaine on effectiveness of nerve block, and postoperative pain in forearm fracture surgery by supraclavicular BPB undergoing ultrasound-guided. Methods This was a double-blinded randomized clinical trial conducted on 72 patients with ASA classes I and II, which were candidates for forearm fracture surgery. In group A, patients received 3 mg/kg of lidocaine 2%. In group B, patients received 3 mg/kg of lidocaine 2% and DEX (1 µg/kg). The ultrasound-guided supraclavicular BPB was performed in all patients. The onset of sensory and motor blocks were evaluated with pin prick test and modified Bromage scale, respectively. The sensory and motor block moment was recorded as the onset of the block. The first analgesic request time, total consumed analgesic, adverse effect, and hemodynamic parameters of patients were recorded. A visual analog scale (VAS) was used for recording the severity of pain. Results The two groups showed no significant difference in the demographic variables. The onset of sensory and motor block in the DEX groups was shorter. The duration of sensory and motor block, and analgesic request was significantly longer than the control groups. Total analgesic consumption 24 hours after surgery in the DEX groups was significantly lower. Moreover, hemodynamic status of patients in both groups was stable and no significant difference was observed between groups. This study showed that DEX, as an adjuvant to lidocaine, improve the characteristics of supraclavicular BPB and decrease the postoperative pain.
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Affiliation(s)
- Reza Akhondzadeh
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology, Pain Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Ave., Ahvaz, Iran. Tel/Fax: +98-6132220168,
| | - Mahbobe Rashidi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Gousheh
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Olapour
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amirhossein Baniahmad
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chen Q, An R, Zhou J, Yang B. Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis. PLoS One 2018; 13:e0198923. [PMID: 29902215 PMCID: PMC6002066 DOI: 10.1371/journal.pone.0198923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Perineural dexamethasone has been shown to prolong the duration of local anesthetic (LA) effect in regional anesthesia; however, the use of perineural dexamethasone as an adjuvant to to the transversus abdominis plane (TAP) block remains controversial. This meta-analysis sought to assess the efficacy of dexamethasone in prolonging the TAP block and enhancing recovery after abdominal surgery. METHODS We identified and analyzed 9 RCTs published on or before September 30, 2017, regardless of the original language, after searching the following 6 bibliographic databases: PubMed, EMBASE, Medline, Springer, Ovid, and the Cochrane Library. databases. These studies compared the effects of perineural dexamethasone mixed with local anesthetic versus local anesthetic alone in the TAP block. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. The primary outcomes were the time until the first request for postoperative analgesics and the analog pain scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes were the analgesic consumption and the incidence of nausea and vomiting on the first day after surgery. We used Trial Sequential Analysis (TSA) to control for random errors. RESULTS Perineural dexamethasone prolonged the duration of LA effect in the TAP block [mean difference (MD): 2.98 h; 95% confidence interval (CI): 2.19 to 3.78] and reduced analog pain scores at 2 h [MD: -1.15; 95% CI: -2.14 to -0.16], 6 h [MD: -0.97; 95% CI: -1.51 to -0.44], and 12 h [MD: -0.93; 95% CI: -1.14 to -0.72] postoperatively. Furthermore, the use of perineural dexamethasone was associated with less analgesic consumption [standard mean difference: -1.29; 95% CI: -1.88 to -0.70] and a lower incidence of nausea and vomiting [odds ratio: 0.28; 95% CI: 0.16 to 0.49] on the first day after surgery. CONCLUSION Dexamethasone prolongs the LA effect when used as an adjuvant in the TAP block and improves the analgesic effects of the block.
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Affiliation(s)
- Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Ran An
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Ju Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Bin Yang
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
- * E-mail:
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Kirkham KR, Jacot-Guillarmod A, Albrecht E. Optimal Dose of Perineural Dexamethasone to Prolong Analgesia After Brachial Plexus Blockade. Anesth Analg 2018; 126:270-279. [DOI: 10.1213/ane.0000000000002488] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hamed MA, Ghaber S, Reda A. Dexmedetomidine and Fentanyl as an Adjunct to Bupivacaine 0.5% in Supraclavicular Nerve Block: A Randomized Controlled Study. Anesth Essays Res 2018; 12:475-479. [PMID: 29962619 PMCID: PMC6020562 DOI: 10.4103/aer.aer_50_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Brachial plexus block is gaining popularity day by day for upper limb surgery. The supraclavicular brachial plexus block may be used for surgical anesthesia alone or in conjunction with general anesthesia. Aims We intended to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine on onset and duration of block and postoperative analgesia during ultrasonic guided supraclavicular nerve block for upper limb surgeries. Settings and Design This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods Sixty patients with American Society of Anesthesiologists physical status Classes I and II, aged 18-50 years, scheduled for upper limb surgery were randomly divided into three study groups each group contains 20 patients: C Group: receive 0.5 mL/kg up to a maximum of 40 mL volume. The dose of bupivacaine was 1.5 mg/kg. D Group: Bupivacaine as control group + 1 mg/kg dexmedetomidine. F Group: Bupivacaine as control group + 1 mg/kg fentanyl. Patients were observed for onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects. Statistical Analysis Used One-way ANOVA test and Chi-square test were used. Results The onset time of sensory and motor blockade was shortened. and the duration of the block was significantly prolonged in the D Group (P < 0.001) and F Group (P < 0.001). The duration of postoperative analgesia was also longer in the D Group 13.5 h compared with the F Group 8.3 h and C Group 7.5 h. Hypotension and bradycardia were recorded in 2 patients in D Group, and nausea and vomiting were recorded in F Group. Conclusions Addition of dexmedetomidine was better in prolongation of the duration of supraclavicular brachial plexus block and improvement of postoperative analgesia than fentanyl and bupivacaine alone without significant adverse effects in patients undergoing upper limb surgeries.
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Affiliation(s)
- Mohamed Ahmed Hamed
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Saffa Ghaber
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmed Reda
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Koraki E, Stachtari C, Kapsokalyvas I, Stergiouda Z, Katsanevaki A, Trikoupi A. Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block. J Clin Pharm Ther 2017; 43:348-352. [DOI: 10.1111/jcpt.12657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Affiliation(s)
- E. Koraki
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
| | - C. Stachtari
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
| | - I. Kapsokalyvas
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
| | - Z. Stergiouda
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
| | - A. Katsanevaki
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
| | - A. Trikoupi
- Department of Anesthesiology; General Hospital of Thessaloniki “G. Papanikolaou”; Thessaloniki Greece
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Pehora C, Pearson AME, Kaushal A, Crawford MW, Johnston B. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database Syst Rev 2017; 11:CD011770. [PMID: 29121400 PMCID: PMC6486015 DOI: 10.1002/14651858.cd011770.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peripheral nerve block (infiltration of local anaesthetic around a nerve) is used for anaesthesia or analgesia. A limitation to its use for postoperative analgesia is that the analgesic effect lasts only a few hours, after which moderate to severe pain at the surgical site may result in the need for alternative analgesic therapy. Several adjuvants have been used to prolong the analgesic duration of peripheral nerve block, including perineural or intravenous dexamethasone. OBJECTIVES To evaluate the comparative efficacy and safety of perineural dexamethasone versus placebo, intravenous dexamethasone versus placebo, and perineural dexamethasone versus intravenous dexamethasone when added to peripheral nerve block for postoperative pain control in people undergoing surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, DARE, Web of Science and Scopus from inception to 25 April 2017. We also searched trial registry databases, Google Scholar and meeting abstracts from the American Society of Anesthesiologists, the Canadian Anesthesiologists' Society, the American Society of Regional Anesthesia, and the European Society of Regional Anaesthesia. SELECTION CRITERIA We included all randomized controlled trials (RCTs) comparing perineural dexamethasone with placebo, intravenous dexamethasone with placebo, or perineural dexamethasone with intravenous dexamethasone in participants receiving peripheral nerve block for upper or lower limb surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 35 trials of 2702 participants aged 15 to 78 years; 33 studies enrolled participants undergoing upper limb surgery and two undergoing lower limb surgery. Risk of bias was low in 13 studies and high/unclear in 22. Perineural dexamethasone versus placeboDuration of sensory block was significantly longer in the perineural dexamethasone group compared with placebo (mean difference (MD) 6.70 hours, 95% confidence interval (CI) 5.54 to 7.85; participants1625; studies 27). Postoperative pain intensity at 12 and 24 hours was significantly lower in the perineural dexamethasone group compared with control (MD -2.08, 95% CI -2.63 to -1.53; participants 257; studies 5) and (MD -1.63, 95% CI -2.34 to -0.93; participants 469; studies 9), respectively. There was no significant difference at 48 hours (MD -0.61, 95% CI -1.24 to 0.03; participants 296; studies 4). The quality of evidence is very low for postoperative pain intensity at 12 hours and low for the remaining outcomes. Cumulative 24-hour postoperative opioid consumption was significantly lower in the perineural dexamethasone group compared with placebo (MD 19.25 mg, 95% CI 5.99 to 32.51; participants 380; studies 6). Intravenous dexamethasone versus placeboDuration of sensory block was significantly longer in the intravenous dexamethasone group compared with placebo (MD 6.21, 95% CI 3.53 to 8.88; participants 499; studies 8). Postoperative pain intensity at 12 and 24 hours was significantly lower in the intravenous dexamethasone group compared with placebo (MD -1.24, 95% CI -2.44 to -0.04; participants 162; studies 3) and (MD -1.26, 95% CI -2.23 to -0.29; participants 257; studies 5), respectively. There was no significant difference at 48 hours (MD -0.21, 95% CI -0.83 to 0.41; participants 172; studies 3). The quality of evidence is moderate for duration of sensory block and postoperative pain intensity at 24 hours, and low for the remaining outcomes. Cumulative 24-hour postoperative opioid consumption was significantly lower in the intravenous dexamethasone group compared with placebo (MD -6.58 mg, 95% CI -10.56 to -2.60; participants 287; studies 5). Perinerual versus intravenous dexamethasoneDuration of sensory block was significantly longer in the perineural dexamethasone group compared with intravenous by three hours (MD 3.14 hours, 95% CI 1.68 to 4.59; participants 720; studies 9). We found that postoperative pain intensity at 12 hours and 24 hours was significantly lower in the perineural dexamethasone group compared with intravenous, however, the MD did not surpass our pre-determined minimally important difference of 1.2 on the Visual Analgue Scale/Numerical Rating Scale, therefore the results are not clinically significant (MD -1.01, 95% CI -1.51 to -0.50; participants 217; studies 3) and (MD -0.77, 95% CI -1.47 to -0.08; participants 309; studies 5), respectively. There was no significant difference in severity of postoperative pain at 48 hours (MD 0.13, 95% CI -0.35 to 0.61; participants 227; studies 3). The quality of evidence is moderate for duration of sensory block and postoperative pain intensity at 24 hours, and low for the remaining outcomes. There was no difference in cumulative postoperative 24-hour opioid consumption (MD -3.87 mg, 95% CI -9.93 to 2.19; participants 242; studies 4). Incidence of severe adverse eventsFive serious adverse events were reported. One block-related event (pneumothorax) occurred in one participant in a trial comparing perineural dexamethasone and placebo; however group allocation was not reported. Four non-block-related events occurred in two trials comparing perineural dexamethasone, intravenous dexamethasone and placebo. Two participants in the placebo group required hospitalization within one week of surgery; one for a fall and one for a bowel infection. One participant in the placebo group developed Complex Regional Pain Syndrome Type I and one in the intravenous dexamethasone group developed pneumonia. The quality of evidence is very low due to the sparse number of events. AUTHORS' CONCLUSIONS Low- to moderate-quality evidence suggests that when used as an adjuvant to peripheral nerve block in upper limb surgery, both perineural and intravenous dexamethasone may prolong duration of sensory block and are effective in reducing postoperative pain intensity and opioid consumption. There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not apply to participants at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe.There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not be apply to participants who at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe. The nine ongoing trials registered at ClinicalTrials.gov may change the results of this review.
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Affiliation(s)
- Carolyne Pehora
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Annabel ME Pearson
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Alka Kaushal
- Max Rady College of Medicine, University of ManitobaDepartment of Family MedicineWinnipegManitobaCanada
| | - Mark W Crawford
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Bradley Johnston
- Dalhousie UniversityDepartment of Community Health and Epidemiology5790 University AvenueHalifaxNSCanadaB3H 1V7
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Yang SH, Sun WG, Li YL, Chen XN, Qi DM, Sun YJ. [Effects of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:833-836. [PMID: 28669962 PMCID: PMC6744140 DOI: 10.3969/j.issn.1673-4254.2017.06.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To observe the anesthetic effect and safety of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery. METHODS Eighty children undergoing polydactyly surgery were randomized into 4 groups to receive brachial plexus nerve block with dexmedetomidine at 0.25, 0.50 or 0.75 µg/kg combined with 0.25% ropivacaine (0.20 mL/kg) (D1, D2, and D3 groups, respectively) or with 0.25% ropivacaine (0.20 mL/kg) only (control group). The onset time, duration of brachial plexus nerve block, awakening time, success rate, and incidence of complications were compared among the groups. Results In D2 and D3 groups, the onset time and awakening time were shorter and anesthesia lasted longer than those in the control group. The onset time and awakening time were shorter and anesthesia maintenance time was longer in D3 group than in D1 group. The success rates of brachial plexus nerve block were significantly higher in D1-3 groups than in the control group (P<0.05). Hematoma was found in one of the patients. In each of the 4 groups, laryngeal nerve block occurred in 1 child and respiratory depression in another; 2 or 3 patients had Horner syndrome, and 1 patient in D3 group experienced an episode of lowered heart beat to below 70 min-1. All the complications were managed properly and the patients all recovered uneventfully. CONCLUSION Brachial plexus nerve block with 0.5 µg/kg dexmedetomidine combined with 0.25% ropivacaine (0.20 mL/kg) is safe for effective anesthesia in children undergoing surgery for polydactyly.
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Affiliation(s)
- Shi-Hui Yang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 510010, China. E-mail:
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Sakae TM, Marchioro P, Schuelter-Trevisol F, Trevisol DJ. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial. J Clin Anesth 2017; 38:133-136. [PMID: 28372653 DOI: 10.1016/j.jclinane.2017.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB). DESIGN Randomized clinical trial. SETTING, PATIENTS AND INTERVENTIONS Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0.75% ropivacaine with 1ml of isotonic saline (C group, n=20), 20ml of 0.75% ropivacaine with 1ml (4mg) of perineural dexamethasone (Dpn group, n=20), or 20ml of 0.75% ropivacaine with 1ml of isotonic saline and intravenous 4mg dexamethasone (IV) (Div group, n=20). A nerve stimulation technique with ultrasound was used in all patients. MEASUREMENTS The onset time and duration of sensory blocks were assessed. Secondary outcomes were pain scores (VAS) and postoperative vomiting and nausea (PONV). MAIN RESULTS The duration of the motor and sensory block was extended in group Dpn compared with group Div and group C (P<0.05). In addition, within 24h, group Dpn presented lower levels of VAS and lower incidence of PONV as compared with the other groups. Moreover, there was a significant reduction on onset time between group Dpn and the other groups. CONCLUSIONS Perineural 4mg dexamethasone was more effective than intravenous in extending the duration of ropivacaine in ultrasound-guided interscalene BPB. Moreover, Dpn has significant effects on onset time, PONV, and VAS.
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Affiliation(s)
- Thiago Mamôru Sakae
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina - Unisul, Brazil.
| | | | - Fabiana Schuelter-Trevisol
- Clinical Research Center, Hospital Nossa Senhora da Conceição, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina - Unisul, Brazil.
| | - Daisson José Trevisol
- Clinical Research Center, Hospital Nossa Senhora da Conceição, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina - Unisul, Brazil.
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Vorobeichik L, Brull R, Abdallah F. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2017; 118:167-181. [DOI: 10.1093/bja/aew411] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e5846. [PMID: 28121930 PMCID: PMC5287954 DOI: 10.1097/md.0000000000005846] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Brachial plexus block (BPB) for upper extremity surgery provides superior analgesia, but this advantage is limited by the pharmacological duration of local anesthetics. Dexmedetomidine (DEX) as a local anesthetics adjuvant for BPB has been utilized to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in the efficacy and safety of the perineural route. Hence, an updated meta-analysis was conducted to assess the efficacy and safety of DEX as local anesthetic adjuvants on BPB. METHODS A search in electronic databases was conducted to collect the RCTs that investigated the impact of adding DEX to local anesthetics for BPB. Sensory block duration, motor block duration, onset time of sensory and motor block, time to first analgesic request, the common adverse effects were analyzed. RESULTS Eighteen trails (1014 patients) were included with 515 patients receiving perineural DEX. The addition of DEX prolonged the duration of sensory block (WMD 257 minutes, 95%CI 191.79-322.24, P < 0.001), motor block (WMD 242 minutes, 95%CI 174.94-309.34, P < 0.001), and analgesia (WMD 26 6 minutes, 95%CI 190.75-342.81, P < 0.001). Perineural DEX also increased the risk of bradycardia (OR=8.25, 95%CI 3.95-17.24, P < 0.001), hypotension (OR = 5.62, 95%CI 1.52-20.79, P < 0.01), and somnolence (OR = 19.67, 95%CI 3.94-98.09, P < 0.001). There was a lack of evidence that perineural DEX increased the risk of other adverse events. CONCLUSIONS DEX is a potential anesthetic adjuvant that can facilitate better anesthesia and analgesia when administered in BPB. However, it also increased the risk of bradycardia, hypotension, and somnolence. Further research should focus on the efficacy and safety of the preneural administration of DEX.
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Affiliation(s)
- Yongmei Ping
- Department of Anaesthesiology, Maternal and Children Hospital of Lishui City, Lishui
| | - Qigang Ye
- Department of Anaesthesiology, Taizhou First People's Hospital and Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Wenwei Wang
- Department of Anaesthesiology, Taizhou First People's Hospital and Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Pingke Ye
- Department of Anaesthesiology, Taizhou First People's Hospital and Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Zhibin You
- Department of Anaesthesiology, Taizhou First People's Hospital and Huangyan Hospital of Wenzhou Medical University, Taizhou, China
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Kim SY, Cheon JH, Seo WJ, Yang GY, Choi YM, Kim KH. A pictorial review of signature patterns living in musculoskeletal ultrasonography. Korean J Pain 2016; 29:217-228. [PMID: 27738500 PMCID: PMC5061638 DOI: 10.3344/kjp.2016.29.4.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 11/05/2022] Open
Abstract
The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.
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Affiliation(s)
- Su Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Ji Hyun Cheon
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Won Jun Seo
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Young Yang
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Yun Mi Choi
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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