Comparison of dexmedetomidine and dexamethasone as adjuvants to the ultrasound-guided interscalene nerve block in arthroscopic shoulder surgery: a systematic review and Bayesian network meta-analysis of randomized controlled trials

Effect of Ultrasound-Guided External Oblique Intercostal Block on Postoperative Recovery After Subxiphoid Video-Assisted Thoracoscopic Thymectomy: A Randomized Controlled Trial

OBJECTIVE

Severe postoperative pain can occur after subxiphoid video-assisted thoracoscopic thymectomy (SVATT), affecting the quality of postoperative recovery. This study aimed to evaluate the effect of ultrasound-guided external oblique intercostal (EOI) block on recovery after SVATT.

METHODS

A total of 60 patients undergoing SVATT were randomly divided into the EOI group (group E, n = 30) and the control group (group C, n = 30). Group E underwent ultrasound-guided bilateral EOI block at the 6th rib level and was injected 20 mL of 0.375% ropivacaine on each side. Group C was injected with 20 mL of 0.9% saline at the same site. After the operation, both groups received a patient-controlled intravenous analgesic (PCIA) pump. The 15-item Quality of Recovery (QoR-15) scores were recorded at 24 hours before surgery (T0), 24 hours after surgery (T3), and 48 hours after surgery (T4). The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, the time of first pressing PCIA, and the cases of rescue analgesia were recorded. The visual analog scale (VAS) scores of patients at 6 (T1), 12 (T2), 24 (T3), and 48 hours (T4) after an operation during rest and coughing were recorded. The dermatomes of the sensory plane, block complications in group E, and the incidence of other postoperative adverse reactions in both groups were also recorded.

RESULTS

Compared with group C, the QoR-15 scores of patients were significantly higher at T3 and T4 in the group E. The VAS scores were significantly lower at T1, T2, and T3 during rest and coughing in the group E. The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, and the cases of rescue analgesia were significantly lower in group E, and the time of first pressing PCIA was significantly increased in group E (all P < .05).

CONCLUSION

Ultrasound-guided EOI block can be safely used in patients undergoing SVATT, which can improve the quality of postoperative recovery and reduce postoperative pain.

Timing of intravenous dexamethasone and analgesia after brachial plexus block: a randomized, double-blind, placebo-controlled trial

BACKGROUND

The addition of intravenous dexamethasone can significantly prolong analgesia and reduce opioid-related side effects after brachial plexus blockade, but the most effective administration time is yet unknown. The objective of this study is to determine if the timing of administration of dexamethasone affects the duration of analgesia after supraclavicular brachial plexus block.

METHODS

This is a double-blind, placebo-controlled, randomized trial performed at a single-center, tertiary academic health sciences center. Patients were randomly assigned to one of four treatment groups to receive dexamethasone 8 mg intravenously (or normal saline infusions) at 1-hour preblock, at the time of the block, and 1 or 2 hours postblock.

RESULTS

197 patients were randomized and received the intervention (in one of four treatment groups) between January 2018 and November 2023. 39 patients were excluded due to loss to follow-up and unavailability of primary outcome data. The remaining 158 patients have complete data sets and were analyzed. The time to first reported pain was not significantly different between groups (p=0.904). Secondary outcomes including pain scores and opioid consumption, recovery scores and block recovery time did not vary significantly among groups up to 48 hours. Adverse effects such as postoperative neurological symptoms and nausea were similar across groups up to 3 months postoperatively.

CONCLUSIONS AND RELEVANCE

Our results suggest that perioperative administration of 8 mg of intravenous dexamethasone (from 1 hour prior and up to 2 hours postblock) provides similar duration of analgesia to administration at the time of brachial plexus block.

TRIAL REGISTRATION NUMBER

NCT03394820.

Continuous Catheter Versus Single-Shot Interscalene Block in Shoulder Surgery: A Review and Recommendations for Postoperative Pain Management

Shoulder arthroscopic and arthroplastic surgeries are associated with significant postoperative pain, which can delay recovery and increase opioid consumption. Interscalene blocks (ISBs) are a commonly used method to manage this pain, either as single-shot injections or continuous catheter infusions (CISBs). This review synthesizes findings from studies conducted in the past five years, comparing the efficacy, complications, and outcomes of single-shot ISBs versus CISBs for postoperative pain management in shoulder surgeries. Current literature highlights key differences: single-shot ISBs provide significant immediate postoperative pain relief, whereas CISBs offer prolonged analgesia beyond 48 hours, reduced opioid consumption, and enhanced recovery outcomes. However, CISBs carry a higher risk of complications and procedural complexity compared to single-shot ISBs. Both single-shot ISBs and CISBs present effective options for postoperative pain control in shoulder surgery patients. Single-shot ISBs may be preferable for patients seeking immediate pain relief with fewer complications, while CISBs are beneficial for those requiring prolonged analgesia. The choice of technique should be individualized based on the patient's needs, expected recovery, and potential risk factors.