Intrathecal ropivacaine with or without tramadol for lower limb orthopedic surgeries

Perioperative outcomes following preoperative epidural analgesia in hip fracture patients undergoing surgical repair: A systematic review

OBJECTIVE

To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair.

DESIGN

Systematic review.

METHODS

The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated.

RESULTS

Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies.

CONCLUSIONS

Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.

Isobaric ropivacaine with or without dexmedetomidine for surgery of neck femur fracture under subarachnoid block

Background and Aims:

Dexmedetomidine has a promising role as an intrathecal adjuvant. However it's role as an adjuvant to ropivacaine has not been evaluated extensively. This study is designed to find out the effect of addition of dexmedetomidine 5 μg to isobaric ropivacaine 18.75 mg on block characteristics and hemodynamic parameters in patients undergoing surgeries for fracture neck of femur under subarachnoid block (SAB).

Material and Methods:

Sixty-one American Society of Anesthesiologists (ASA) Class I or II patients between 18–60 years undergoing surgeries for fracture neck of femur under SAB were recruited and randomized into two groups. Thirty patients in Group RN received 2.5 ml isobaric ropivacaine 0.75% (18.75 mg) with 0.5 ml normal saline (NS) to make a total volume of 3 ml, while 31 patients in Group RD received 2.5 ml isobaric ropivacaine 0.75% with dexmedetomidine 5 μg diluted with NS to make a total volume of 3 ml. The block characteristics, hemodynamic parameters, and side effects were recorded in both the groups.

Results:

Patients in Group RD had significantly longer duration of sensory block (202.90 ± 50.2 min) compared to Group RN (157.33 ± 31.6 min), P < 0.001. Time to first rescue analgesia request was significantly longer in the Group RD compared to Group RN (265.16 ± 71.4 min vs 203.67 ± 35.6 min, respectively) (P < 0.001). However, the sensory block onset, maximum block height, time to two dermatomal regression, and motor block intensity remained unaltered. Incidence of side effects like hypotension, bradycardia, nausea, vomiting, and shivering were statistically similar in both the groups.

Conclusion:

Addition of 5 μg dexmedetomidine enhances the analgesic effect of intrathecal 18.75 mg isobaric ropivacaine for the conduct of fracture neck of femur surgeries with minimal adverse events.