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Park SU, Kim T, Do J, Cho M, An JS, Karm MH. Comparison of safety of general anesthesia and intravenous sedation during third-molar extraction surgery. Sci Rep 2024; 14:16687. [PMID: 39030390 PMCID: PMC11271491 DOI: 10.1038/s41598-024-67045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024] Open
Abstract
This study compared the safety of general anesthesia (GA) and intravenous sedation (IVS) in patients who underwent extraction of one or more third molars. Data from 1260 patients (GA group, n = 1043; IVS group, n = 217) were retrospectively analyzed, including demographics, preoperative data, intraoperative hemodynamic parameters (blood pressure, heart rate, and oxygen saturation level), and medications administered intraoperatively and postoperatively. The incidence of intraoperative circulatory variations, surgery and anesthesia durations, postoperative complications, and medication use were assessed and compared. The GA group had longer anesthesia and surgery durations, a higher incidence of hypotension, and a higher frequency of postoperative analgesic use than the IVS group. Dexmedetomidine was the most frequently used sedative agent. The IVS group had a lower incidence of intraoperative hypotension but they had a higher need for vasopressors in the recovery room. Both anesthesia methods maintained satisfactory oxygen saturation levels and sufficient anesthesia throughout the procedure, but they showed different characteristics regarding the duration of surgery and anesthesia duration, hemodynamic stability, and postoperative analgesic needs. IVS may be preferable for patients at risk of cardiovascular complications such as hypotension or tachycardia during surgery.
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Affiliation(s)
- Se-Ung Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Taewoo Kim
- Department of Dental Anesthesiology, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jiwon Do
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea
| | - Mincheul Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, 13620, Republic of Korea
| | - Jung-Sub An
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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刘 典, 黄 文, 翟 文, 李 颖, 陈 东, 郑 仕, 吴 颖, 卢 伟. [A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:448-454. [PMID: 38632065 PMCID: PMC11024521 DOI: 10.7507/1002-1892.202312103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups ( P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups ( P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant ( P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group ( P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points ( P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups ( P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups ( P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation ( P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points ( P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
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Affiliation(s)
- 典琦 刘
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 文彬 黄
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 文润 翟
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 颖芬 李
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 东峰 陈
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 仕聪 郑
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 颖斌 吴
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
| | - 伟杰 卢
- 广州医科大学附属第一医院关节外科(广州 510120)Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China
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Heo Y, Yang M, Nam SM, Lee HS, Kim YD, Won HS. New insight into the vasto-adductor membrane for safer adductor canal blockade. Korean J Pain 2024; 37:132-140. [PMID: 38433475 PMCID: PMC10985484 DOI: 10.3344/kjp.23292] [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: 10/19/2023] [Revised: 11/23/2023] [Accepted: 12/16/2023] [Indexed: 03/05/2024] Open
Abstract
Background : This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). Methods : Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. Results : The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. Conclusions : Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.
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Affiliation(s)
- Yanguk Heo
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Miyoung Yang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
- Sarcopenia Total Solution Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung Min Nam
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyun Seung Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Yeon-Dong Kim
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
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Kim YS, Lee C, Oh J, Nam S, Doo AR. Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports. World J Clin Cases 2023; 11:7469-7474. [PMID: 37969436 PMCID: PMC10643066 DOI: 10.12998/wjcc.v11.i30.7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Dexmedetomidine (DMED) is frequently used as a sedative in several medical fields. The benefits of DMED include enhanced quality of regional anesthesia, prolonged analgesia, and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia. Severe hemodynamic complications, such as profound bradycardia and hypotension, can occur after DMED administration in critically ill patients or overdosage; however, there are few reports of complications with DMED administration following brachial plexus block (BPB). CASE SUMMARY We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB. A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9 μg/kg for 9 min. DMED administration was promptly stopped, and after receiving a second dose of atropine, the heart rate recovered. A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly, requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5 μg/kg for 10 min. Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction. Decreased blood pressure was maintained despite the intravenous administration of ephedrine. With continuous infusion of dopamine and norepinephrine, the vital signs were maintained within normal ranges. Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED. CONCLUSION DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.
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Affiliation(s)
- Ye Sull Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - Chanhong Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - Jeongmin Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - Seonhwa Nam
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, South Korea
- Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
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Fernández Martin MT, Alvarez Lopez S, Aldecoa Alvarez-Santullano C. Role of adjuvants in regional anesthesia: A systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:97-107. [PMID: 36813032 DOI: 10.1016/j.redare.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 02/22/2023]
Abstract
The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines. The 79 studies selected using our criteria showed a clear prevalence of dexamethasone (n=24) and dexmedetomidine (n=33) over other adjuvants. Different meta-analyses comparing adjuvants suggest that dexamethasone administered perineurally achieves superior blockade with fewer side effects than dexmedetomidine. Based on the studies reviewed, we found moderate evidence to recommend the use of dexamethasone as an adjuvant to peripheral regional anaesthesia in surgeries that can cause moderate to severe pain.
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Affiliation(s)
- M T Fernández Martin
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - S Alvarez Lopez
- Servicio de Anestesiología y Reanimación, Hospital Abente y Lago, A Coruña, Spain
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[Research progress on analgesic effect of adductor canal block after knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:106-114. [PMID: 36708123 PMCID: PMC9883644 DOI: 10.7507/1002-1892.202210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. Methods The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. Results In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once "gold standard" femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. Conclusion ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.
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Lee JE, Park HJ, Chung YJ, Ahn HJ, Sim WS, Lee JY. Analgesic effect of dexmedetomidine in colorectal cancer patients undergoing laparoscopic surgery. Saudi Med J 2022; 43:1096-1102. [PMID: 36261202 PMCID: PMC9994502 DOI: 10.15537/smj.2022.43.10.20220526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate the analgesic efficacy of intraoperative dexmedetomidine (DEX) for acute postoperative pain in colorectal cancer patients undergoing laparoscopic surgery. METHODS We retrospectively analyzed data of 190 colorectal cancer patients who had undergone laparoscopic surgery between October 2020 and May 2021 at Samsung Medical Center, Seoul, Korea, with (n=74) or without intraoperative DEX (n=85) administration. The demographic, clinical, anesthetic, and postoperative data were compared. RESULTS In total, 159 patients were enrolled. Demographic and clinical data were not different between the groups. The mean arterial pressure (p<0.001) and heart rate (p<0.001) were lower in the DEX group at the end of surgery and after extubation (p=0.003, p=0.001). The minimum alveolar concentration of sevoflurane was lower in the DEX group during surgery. At the post-anesthesia care unit (PACU) admission and discharge, pain scores (p<0.001, p=0.027) and fentanyl consumption (p<0.001) were significantly lower in the DEX group. On postoperative days 1-3, pain scores and opioid consumption were not different between the groups. The incidence of postoperative complications was not different between the groups. CONCLUSION Continuous intraoperative DEX administration had an intraoperative analgesic effect as indicated by lower hemodynamic and fentanyl consumption. Furthermore, there was immediate postoperative analgesia as suspected by the lower pain scores and fentanyl dose during the PACU. However, pain scores and opioid consumption after the PACU remained unaffected.
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Affiliation(s)
- Ja E. Lee
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hue J. Park
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Yoon J. Chung
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hyun J. Ahn
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Woo S. Sim
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jin Y. Lee
- From the Department of Anesthesiology and Pain Medicine (JE. Lee, Chung, Ahn, Sim, JY. Lee), Samsung Medical Center, School of Medicine, Sungkyunkwan University, and from the Department of Anesthesiology and Pain Medicine (Park), Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Nair A, Fultambkar G, Kasetty S, Vijayanand B. Dexmedetomidine and clonidine as adjuvants to ropivacaine in adductor canal block for postoperative analgesia in patients undergoing arthroscopic anterior cruciate ligament reconstruction: A prospective, randomized, double-blind study. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_88_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hong B, Oh C, Jo Y, Chung W, Park E, Park H, Yoon S. The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial. J Pers Med 2021; 11:jpm11121267. [PMID: 34945739 PMCID: PMC8703270 DOI: 10.3390/jpm11121267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 12/25/2022] Open
Abstract
Intravenous dexamethasone and dexmedetomidine, in conjunction with peripheral nerve blockade, have each been reported to prolong the duration of analgesia. This study tested whether combined use further prolongs analgesia duration after supraclavicular brachial plexus block (BPB) in patients undergoing orthopedic upper extremity surgery. One hundred twenty patients were randomized 1:1:1:1 to Control (saline bolus and midazolam infusion [0.05 mg/kg loading, 20 µg/kg/h thereafter]); DMED (saline bolus and dexmedetomidine infusion [1 μg/kg loading, 0.4 μg/kg/h thereafter]); DEXA (dexamethasone [10 mg] bolus and midazolam infusion); and DMED-DEXA (dexmedetomidine infusion and dexamethasone bolus) groups. The primary outcome was the duration of postoperative analgesia, defined as the time from the end of the BPB to the first dose of analgesia via a patient-controlled device. Median (interquartile range) times to first dose of analgesia in the Control, DMED, DEXA, and DMED-DEXA groups were 8.1 (6.2–11.6), 9.0 (8.1–11.3), 10.7 (8.1–20.5), and 13.2 (11.5–19.1) hours, respectively (p < 0.001). Pairwise comparisons showed significant prolongation of analgesia in the DEXA included groups compared with the non-DEXA included groups (DEXA vs. control, p = 0.045; DEXA vs. DMED, p = 0.045; DMED-DEXA vs. control, p < 0.001; DMED-DEXA vs. DMED, p < 0.001). A mixed effect model showed that dexamethasone was the only significant factor for the prolongation of analgesia (p < 0.001). Intravenous dexamethasone prolonged the analgesia duration of supraclavicular BPB after orthopedic upper extremity surgery. The concurrent use of mild to moderate sedation dose of intravenous dexmedetomidine in addition to intravenous dexamethasone showed no additional benefit to the prolongation of analgesia.
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Affiliation(s)
- Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
- Big Data Center, Biomedical Research Institute, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
| | - Eunhye Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
| | - Hanmi Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
| | - Seokhwa Yoon
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (B.H.); (C.O.); (Y.J.); (W.C.); (E.P.); (H.P.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
- Correspondence:
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Doo AR, Lee H, Baek SJ, Lee J. Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study. BMC Anesthesiol 2021; 21:207. [PMID: 34525975 PMCID: PMC8444554 DOI: 10.1186/s12871-021-01416-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hemodynamic instability is a frequent adverse effect following administration of dexmedetomidine (DMED). In this study, we evaluated the incidence of DMED-induced hemodynamic instability and its predictive factors in clinical regional anesthesia practice. Methods One hundred sixteen patients who underwent orthopedic upper limb surgery under brachial plexus block with intravenous DMED administration were retrospectively identified. The primary outcome was the incidence of DMED-induced hemodynamic instability. The participants were allocated to a stable or unstable group by their hemodynamic instability status. Patients’ characteristics were compared between the groups. The relationship between the potential risk factors and development of DMED-induced hemodynamic instability was analyzed with a logistic regression model. Results DMED-induced hemodynamic instability was observed in 14.7% of patients (17/116). The unstable group had more women than the stable group (76.5% vs. 39.4%, P = 0.010). When patients were classified into four subgroup according to body mass index (underweight, normal weight, overweight, and obesity), there was significant difference in the composition of the subgroups in the two groups (P = 0.008). In univariate analysis, female sex, obesity, and pre-existing hypertension were significant predictors of DMED-induced hemodynamic instability. Multivariate analysis demonstrated that female sex (adjusted OR 3.86, CI 1.09; 13.59, P = 0.036) and obesity (adjusted OR 6.41, CI 1.22; 33.57, P = 0.028) were independent predictors of DMED-induced hemodynamic instability. Conclusions Female and obese patients are more likely to have hemodynamic instability following intravenous DMED administration in clinical regional anesthesia practice. This study suggests that DMED dose may be diminished to prevent hypotensive risk in these populations. Trial registration This article was retrospectively registered at WHO clinical trial registry platform (Trial number: KCT0005977).
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Affiliation(s)
- A Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeollabuk-do, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hyungseok Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeollabuk-do, South Korea
| | - Seon Ju Baek
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeollabuk-do, South Korea
| | - Jeongwoo Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeollabuk-do, South Korea. .,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
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Feng Y, Chang P, Chen XB, Yang XL, Zhang YJ, Zhang WS. Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review. PAIN MEDICINE 2021. [DOI: 10.31636/pmjua.v6i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and Objective. It is unclear whether perineural administration offers advantages when compared to intravenous dexmedetomidine in local anesthesia. To compare the efficacy of perineural versus intravenous dexmedetomidine as local anesthetic adjuvant, we conducted the meta analysis and systematic review.
Materials and Methods. Two researchers searched MEDLINE, OVID, PubMed, Embase, Cochrane Central, Web of Science and Wanfang data for randomized controlled trials comparing the effect of intravenous versus perineural dexmedetomidine as local anesthetic adjuvant without any language restrictions.
Results. We identified 14 randomized controlled trials (801 patients). The results revealed that the duration of analgesia (SMD: -1.76, 95 % CI, [-2.7, -0.83] P = 0.000, I2 = 96 %), the duration of sensory block (SMD:- 3.99, 95 % CI, [-5.88, -2.0], P = 0.000, I2 = 97.6 %), the duration of motor block (SMD: -1.6, 95 % CI, [-2.78, -0.41] P = 0.008, I 2 = 95.5 %) were significantly longer in the perineural group, when compared to systematic dexmedetomidine. The onset time of sensory block (SMD: 1.55, 95 % CI, [0.16, 2.94] P = 0.028, I2 = 96.7 %) and the onset time of motor block (SMD: 0.84, 95 % CI, [0.17, 1.5] P = 0.013, I2 = 88.3 %) were shorter in perineural group compared to intrave nous dexmedetomidine. Meanwhile, analgesic consumption in 24 hours (SMD: 0.37, 95 % CI, [0.05, 0.69] P = 0.023, I 2 = 55.6 %) and the incidence of patients of Ramsay Sedation Scale > 3 (RR: 3.8, 95 % CI, [1.45, 9.97] P = 0.000, I 2 = 26.9 %), hypotension (RR: 1.74, 95 % CI, [1.15, 2.65] P= 0.009, I2 = 32.7 %) and bradycardia (RR: 3.71, 95 % CI, [1.27, 10.86] P = 0.017, I2 = 0 %) were lower in perineural dexmedetomidine compared to the intravenous group.
Conclusions. Our meta-analysis generates the evidence that perineural dexmedetomidine is a superior adminstration for prolonging the duration of analgesia. Perineural dexmedetomidine also shows the advantages in duration of sensory block and the onset time of sensory and motor block, when compared to the intravenous administration. Simultaneously, dexmedetomidine as a local anesthetic adjuvant for perineural injection may be much safer than intravenous application because of the lower incidence of patients of Ramsay Sedation Scale > 3 and lower incidence of hypotension and bradycardia.
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12
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Hussain N, Brummett CM, Brull R, Alghothani Y, Moran K, Sawyer T, Abdallah FW. Efficacy of perineural versus intravenous dexmedetomidine as a peripheral nerve block adjunct: a systematic review. Reg Anesth Pain Med 2021; 46:704-712. [PMID: 33975918 DOI: 10.1136/rapm-2020-102353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dexmedetomidine is an effective local anesthetic adjunct for peripheral nerve blocks. The intravenous route for administering dexmedetomidine has been suggested to be equally effective to the perineural route; but comparative evidence is conflicting. OBJECTIVES This evidence-based review evaluated trials comparing the effects of intravenous to perineural dexmedetomidine on peripheral nerve block characteristics in adult surgical patients. Our primary aim was to evaluate the durations of sensory and motor blockade. Duration of analgesia, onset times of sensory and motor blockade, analgesic consumption, rest pain, and dexmedetomidine-related adverse events were evaluated as secondary outcomes. EVIDENCE REVIEW We sought randomized trials comparing the effects of intravenous to perineural dexmedetomidine on peripheral nerve block characteristics. The Cochrane Risk of Bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation criteria was used to evaluate the quality of evidence for when an outcome was reported by at least three studies. RESULTS Ten studies compared intravenous and perineural dexmedetomidine in the setting of upper extremity blocks (seven), lower extremity blocks (two), and truncal block (one). The doses of dexmedetomidine supplementing long-acting local anesthetics varied between a predetermined dose (50 μg) and a weight-based dose (0.5 μg/kg-1.0 μg/kg). Clinical diversity precluded quantitative pooling; and evidence is presented as a systematic review. Compared with the intravenous route, moderate quality evidence found that perineural dexmedetomidine prolonged the duration of sensory blockade in four of six trials and motor blockade in five of seven trials. Perineural dexmedetomidine also hastened the onset of sensory and motor blockade in three of six trials. No differences were reported for the remaining outcomes; and intravenous dexmedetomidine was not superior for any outcome in any of the trials. CONCLUSIONS Moderate quality evidence appears to suggest that intravenous dexmedetomidine is an inferior peripheral nerve block adjunct compared with perineural dexmedetomidine. Perineural dexmedetomidine is associated with longer durations and faster onset of sensory and motor blockade.
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Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Brull
- Anesthesiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Yousef Alghothani
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kenneth Moran
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tamara Sawyer
- College of Medicine, Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - Faraj W Abdallah
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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Lee KJ, Doo AR. Re: Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. Korean J Pain 2020; 33:284-285. [PMID: 32606273 PMCID: PMC7336344 DOI: 10.3344/kjp.2020.33.3.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ki-Jae Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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