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Nag DS, Gehlot P, Sharma P, Kumar H, Kumar Singh U. Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections. Cureus 2024; 16:e65588. [PMID: 39192898 PMCID: PMC11349148 DOI: 10.7759/cureus.65588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th, and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.
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Affiliation(s)
| | - Priti Gehlot
- Anesthesiology, Steel City Clinic and Research Center, Jamshedpur, IND
| | - Prashant Sharma
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Himanshu Kumar
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Umesh Kumar Singh
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
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Romi R, Hoda W, Kumar S, Bharati B, Toppo S, Singh D, Oraon P, Kumari R, Lakra A, Priye S. Comparative Study of Levobupivacaine Versus Levobupivacaine With Dexmedetomidine as an Adjuvant in Transversus Abdominis Block for Postoperative Pain Relief in Abdominal Hysterectomy Patients: A Randomized, Double-Blind Study. Cureus 2024; 16:e59523. [PMID: 38826898 PMCID: PMC11144035 DOI: 10.7759/cureus.59523] [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] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Adjuvants have been discovered to prolong the analgesic impact of local anesthetics (LA), while the transversus abdominis plane (TAP) block offers sufficient postoperative pain relief after various abdominal procedures. Nevertheless, the impact of the given LA will determine the duration of the TAP block. Thus, in this investigation, we aimed to estimate the analgesic impact of combining dexmedetomidine (DEX) with levobupivacaine in the TAP block for patients having an infraumbilical incision for an abdominal hysterectomy while under spinal anesthetic. Aim This study aimed to determine the analgesic effect of DEX (0.5 mcg/kg) to 20 ml of 0.25% levobupivacaine on each side in the TAP block in patients undergoing total abdominal hysterectomy (TAH). Materials and methods Two groups of 30 patients each, with ASA grades 1 and 2, were randomly selected from patients. Group N, comprising 30 patients, had a bilateral TAP block using 2 mL of normal saline and 20 mL of 0.25% levobupivacaine. Group D (n = 30 patients) was given DEX at a dose of 0.5 mcg/kg (2 mL) in addition to 20 mL of 0.25% levobupivacaine given bilaterally. The TAP block was administered just after skin closure. Time of the initial analgesic dose administration; total fentanyl doses utilized as rescue analgesia; pain scores (numerical rating scale (NRS)) at 2, 4, 6, 8, 12, and 24 hours; and pre- and postoperative cortisol levels were also noted. For each group, 1 gram IV paracetamol was administered every eight hours. Drugs used for rescue analgesia (RA) were diclofenac 75 mg IV stat and fentanyl 1 mcg/kg. Results and discussion In addition to Group N having lower NRS scores at rest, Group D had a considerably longer time for initial rescue analgesia than Group N. There was also a significant decrease in the total fentanyl consumption and postoperative serum cortisol levels in Group D in contrast to Group N. Conclusion Potential adjuvant DEX prolongs postoperative analgesia in patients experiencing abdominal hysterectomy when used alongside LA in TAP.
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Affiliation(s)
- Romi Romi
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Wasimul Hoda
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sourabh Kumar
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Bharati Bharati
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Saurabh Toppo
- Anaesthesiology, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, IND
| | - Dipali Singh
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Priyanka Oraon
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Reena Kumari
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Alka Lakra
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shio Priye
- Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
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Mahmoud Fakhry D, ElMoutaz Mahmoud H, Yehia Kassim D, NegmEldeen AbdElAzeem H. Erector Spinae Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia after Laparoscopic Resection of Colorectal Cancer: A Prospective Randomized Study. Anesthesiol Res Pract 2024; 2024:6200915. [PMID: 38529324 PMCID: PMC10963107 DOI: 10.1155/2024/6200915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024] Open
Abstract
Background In recent years, the attention paid to colorectal cancer (CRC) surgery and postoperative analgesia has increased. Objective The objective of the current study was to compare the impact of ultrasound-guided erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) upon providing relief to patients with postoperative pain who underwent laparoscopic resection for CRC. Methods In this prospective, comparative, and randomized study, the authors considered a total of 60 patients who chose to undergo laparoscopic resection for colorectal cancer. The total number of patients was randomly divided into two groups (such as ESPB and TQLB) so that each group had a total of 30 patients. For the former group, i.e., the ESPB group, 20 ml of 0.25% bupivacaine was administered at each side for bilateral ultrasound-guided erector spinae plane block, while the latter group received the same dose of medicine for bilateral ultrasound-guided transmuscular quadratus lumborum block (TQLB). The researchers recorded the first time to rescue an analgesic, the whole amount of rescue analgesia under consumption in the first 24 hours after the surgical procedure, and associated adverse events. Results Among the groups considered, the ESPB group took a significantly lengthy time to raise a first request for rescue analgesic (280 ± 15.5 min) in comparison with the TQLB group (260 ± 13.8 min). Likewise, the consumption of overall nalbuphine was remarkably lesser in the ESPB group during the first 24 hours (24 ± 2.5 mg) compared to the TQLB group (30.5 ± 1.55 mg). Conclusion The analgesic efficacy of ESPB was better when compared to TQLB in terms of time to rescue analgesia and overall opioid consumption during the first 24 hours. This study was registered at ClinicalTrials.gov on 10/10/2022 (registration number: NCT05574283).
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Affiliation(s)
- Dina Mahmoud Fakhry
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hatem ElMoutaz Mahmoud
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Yehia Kassim
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hebatallah NegmEldeen AbdElAzeem
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Mansour MA, Mahmoud HE, Fakhry DM, Kassim DY. Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study. BMC Anesthesiol 2024; 24:63. [PMID: 38341525 PMCID: PMC10858555 DOI: 10.1186/s12871-024-02432-w] [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: 09/02/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is an association exists between cardiac surgery, performed through median sternotomy, and a considerable postoperative pain. OBJECTIVES The aim of the current study is to compare the effects of transversus thoracic muscle plane block (TTMPB) and pecto-intercostal fascial plane block (PIFB) upon postoperative opioid consumption among the patients who underwent open cardiac surgery. METHODS The present prospective, randomized, comparative study was conducted among 80 patients who underwent elective on-pump cardiac surgery with sternotomy. The subjects were randomly assigned to two groups with each group containing 40 individuals. For the TTMPB group, bilateral ultrasound-guided TTMPB was adopted in which 20 ml of 0.25% bupivacaine was used on each side. In case of PIFB group, bilateral ultrasound-guided PIFB was adopted with the application of 20 ml of 0.25% bupivacaine on each side. The researchers recorded the first time for rescue analgesia, the overall dosage of rescue analgesia administered in the first 24 h after the operation and the postoperative complications. RESULTS The PIFB group took significantly longer time to raise the first request for rescue analgesia (7.8 ± 1.7 h) than the TTMPB group (6.7 ± 1.4 h). Likewise, the PIFB group subjects had a remarkably lower 'overall morphine usage' in the first 24 h after the operation (4.8 ± 1.0 mg) than TTMPB group (7.8 ± 2.0 mg). CONCLUSION Bilateral ultrasound-guided PIFB provided a longer time for the first analgesic demand than bilateral ultrasound-guided TTMPB in patients undergoing open cardiac surgery. In addition to this, the PIFB reported less postoperative morphine usage than the TTMPB and increases satisfaction in these patients. TRIAL REGISTRATION This study was registered at Clinical Trials.gov on 28/11/2022 (registration number: NCT05627869).
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Affiliation(s)
- Mariana AbdElSayed Mansour
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Hatem ElMoutaz Mahmoud
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Mahmoud Fakhry
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Yehia Kassim
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Abu El Hassan SHA, Wahsh EA, Mousa AM, Ibrahim ARN, Mohammed EL. Comparative Study Between Dexmedetomidine with Bupivacaine and Bupivacaine Alone in Erector Spinae Plane Block for Postoperative Pain Control of Posterior Lumbosacral Spine Fixation Surgeries: A Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:351-363. [PMID: 38344257 PMCID: PMC10859055 DOI: 10.2147/dddt.s444485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
Background As posterior lumbosacral spine fixation surgeries are common spine procedures done nowadays due to different causes and mostly accompanied with moderate-to-severe postoperative pain, so should find effective postoperative analgesia for these patients. This study aimed to observe analgesic effect of dexmedetomidine combined with bupivacaine versus bupivacaine alone for erector spinae plane block ESPB for postoperative pain control of posterior lumbosacral spine fixation surgeries. Methods Double-blind randomized controlled study including 90 patients who were randomly allocated into 3 groups (30 patients for each): Dexmedetomidine combined with bupivacaine (DB group), bupivacaine (B group), and saline (control) (S group). US-guided ESPB was performed preoperatively bilaterally in all patients of the 3 groups. All patients received intravenous patient-controlled postoperative analgesia with morphine and 1 gm intravenous paracetamol every 8 hours. Primary clinical outcomes were active (while mobilization) and passive (at rest) visual analog scale (VAS) pain score at first 24 hours measured every 2 hours, opioid consumption (number of PCA presses), and need for rescue analgesia. Other clinical outcomes included active and passive VAS pain score at second 24 hours, measured every 4 hours, opioid consumption, need for rescue analgesia, postoperative opioid side effects, and intraoperative dexmedetomidine side effects as bradycardia and hypotension. Results Active and passive VAS pain scores, postoperative opioid consumption, need for rescue analgesia, and postoperative opioid side effects were significantly lower in DB group when compared to other groups (B and S groups). There were no additional intraoperative dexmedetomidine side effects as bradycardia and hypotension. The estimated effect-size r was -0.58 and Cohen's d was -1.46. Conclusion Addition of dexmedetomidine to bupivacaine 0.25% in ESPB for postoperative pain control in patients of posterior lumbosacral spine fixation surgeries resulted in lower active and passive VAS pain scores, decreased postoperative opioid consumption, need for rescue analgesia and postoperative opioid side effects without additional intraoperative dexmedetomidine side effects. Clinicaltrialsgov Identifier NCT05590234.
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Affiliation(s)
- Sawsan H A Abu El Hassan
- Anesthesiology, Intensive Care and Pain Therapy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Engy A Wahsh
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Giza, 12585, Egypt
| | - Abdelmaksod Mohammed Mousa
- Neurological and Spine Surgery Department, Faculty of Medicine, October 6 University, Giza, 12585, Egypt
| | - Ahmed R N Ibrahim
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, 61421, Saudi Arabia
| | - Emad Lotfy Mohammed
- Anesthesiology, Intensive Care and Pain Therapy, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
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Abo Elfadl GM, Ali WN, Ahmed FN, Abd El-Rady NM, Ali AM, Abdel Rady MM. Add dexmedetomidine to levobupivacaine for transversus abdominis plane block in elderly patients undergoing inguinal hernia repair: Could it make a difference? A randomised trial. J Perioper Pract 2023:17504589231196653. [PMID: 37811840 DOI: 10.1177/17504589231196653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Transversus abdominis plane block is becoming more common as part of multimodal analgesia for post-abdominal operation pain relief. This study compared the analgesic effects of adding dexmedetomidine to levobupivacaine (transversus abdominis plane) block in elderly patients undergoing inguinal hernia surgery to adding fentanyl. METHODS Overall, 90 elderly patients with a simple inguinal hernia repair were randomly assigned to one of three groups. After spinal anaesthesia, an ultrasound-guided transversus abdominis plane block was performed. Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 0.9% normal saline in Group L (n = 30) (20mL). Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 1 µg/kg dexmedetomidine in Group D (n = 30) (20mL). Transversus abdominis plane block was obtained with 0.25% levobupivacaine + 1 µg/kg fentanyl in Group F (n = 30) (20mL). The primary outcome was the first analgesic request, and the secondary outcomes were the visual analog scale, postoperative analgesic requirements, sedation, hemodynamic stability, and related complications 24 hours postoperatively. 1gm paracetamol intravenously was provided as rescue analgesia. RESULTS The time to first analgesic request in the dexmedetomidine group was substantially more prolonged than in the fentanyl and control groups (516.5±27.8, 451.2±11.1, and 403.9±10.5min, respectively; p < 0.05). Postoperative analgesic requirements were significantly decreased in dexmedetomidine 1(1-2) than control 2(1-3) and fentanyl 1.5(1-2) respectively (P<0.01). VAS was significantly lower in Group D and Group F than in Group L postoperatively. No significant difference in side effects was noted between the groups. CONCLUSION The transversus abdominis plane block is the best multimodal analgesia choice for inguinal hernia repair in older patients. Combining dexmedetomidine with levobupivacaine in the transversus abdominis plane block can improve the quality of postoperative analgesia while avoiding significant side effects.
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Affiliation(s)
| | - Wesam Nashat Ali
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Nabil Ahmed
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nessren M Abd El-Rady
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
- Medical Physiology Department, Sphinx University, New Assiut, Assiut, Egypt
| | - Ahmed Mohammed Ali
- Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa Mahmoud Abdel Rady
- Department of Anesthesia and Intensive Care, Faculty of Medicine, New Valley University, New Valley Governorate, Egypt
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Ismail S, Mistry AA, Siddiqui AS, Aziz A, Zuberi NF. The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:557-564. [PMID: 38269169 PMCID: PMC10805223 DOI: 10.4103/joacp.joacp_78_22] [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: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aim Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial. Material and Methods Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia and postoperative analgesia were standardized. Outcome measures were cumulative and rescue tramadol consumption, numerical rating score (NRS) for pain and side effects in post-anesthesia care unit (PACU) at 4, 8, 12 hours postoperatively. Results Tramadol consumption, need for rescue analgesia, and NRS for pain between three groups at 4, 8, and 12 hours postoperatively had no statistically significant difference (P < 0.05). In PACU, median tramadol consumption used for rescue analgesia between group T (15 (15-30)) and group C (30 (15-45)) (P = 0.035), and between group T (15 (15-30)) and group I (30 (15-52)) was statistically significant (P = 0.034). In PACU, the percentage of patients having NRS >4 on movement in group C (72%) compared to group T (46.5%) and group I (46.5%) was significant (P = 0.034). No statistically significant difference was observed in the incidence of side effects among study groups (P > 0.05). Conclusion Except for the immediate postoperative period, neither TAP block nor LAI had added benefit to the multimodal analgesia regimen in patients undergoing gynecological surgeries.
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Affiliation(s)
- Samina Ismail
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Akbar A. Mistry
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Ali S. Siddiqui
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Aliya Aziz
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Pakistan
| | - Nadeem F. Zuberi
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Pakistan
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Guo Y, Wang J, Jiang P, Wang D, Fan W, Yang X. Effect of erector spinae plane block with different doses of dexmedetomidine as adjuvant for ropivacaine on the postoperative quality of recovery after video-assisted thoracoscopic lobectomy surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:264. [PMID: 37550610 PMCID: PMC10405441 DOI: 10.1186/s12871-023-02231-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Erector spinae plane block (ESPB) improves postoperative analgesia and significantly enhances the quality of recovery (QoR) after video-assisted thoracoscopic lobectomy surgery (VATLS). However, it is not known whether the use of dexmedetomidine (Dex) as an adjunct for ropivacaine to ESPB affects the QoR after VATLS. The purpose of this study was to explore the effects of different Dex dosages as an adjunct for ropivacaine in combination with ultrasound-guided ESPB on the quality of postoperative recovery in patients with VATLS. METHODS In this single-center, double-blind, randomized study, 120 patients between the ages of 18 and 65 who were scheduled for VATLS from december 2021 and october 2022 in our hospital under general anesthesia were randomly divided into three groups: ultrasound-guided ESPB with 30 mL of 0.5% ropivacaine (Group R), ultrasound-guided ESPB 0.5% ropivacaine plus 0.5 µg/kg Dex (Group RD1), and ultrasound-guided ESPB 0.5% ropivacaine plus 1.0 µg/kg Dex (Group RD2), ultrasound-guided ESPB was administrated at the T5 vertebral level before surgery. The primary outcome was the QoR-15 score 24 h after the surgery. The secondary outcomes included the QoR-15 scores at 12 h, 48 h, and 72 h after the operation, visual analogue scale (VAS) scores at 8 h, 12 h, 24 h, and 48 h after surgery, cumulative flurbiprofen consumption, postoperative nausea and vomiting (PONV), postoperative bradycardia, and hypotension. RESULTS The QoR-15 scores were higher in group RD2 than the R and RD1 groups on postoperative day 1 (P < 0.05), in addition, no significant difference was found in the QoR-15 scores between groups R and RD1 on postoperative day 1. The VAS scores were significantly lower in group RD2 than in groups RD1 and group R 12-24 h after surgery (P < 0.05). No significant differences were observed in the QoR-15 and VAS scores at 48 and 72 h after surgery between the three groups. The cumulative flurbiprofen consumption was markedly reduced during the 72 h after surgery in the RD2 group (P < 0.05). The incidence of postoperative nausea and vomiting was lower in the RD2 group (P < 0.05). CONCLUSIONS The combination of 1 µg/kg dexmedetomidine as an adjunct with 0.5% ropivacaine 30 ml for erector spinae plane block significantly improved the postoperative quality of recovery and provided better postoperative analgesia on postoperative day 1 in patients undergoing Video-assisted thoracoscopic lobectomy surgery. However, dexmedetomidine (1 µg/kg) as an adjunct for ropivacaine combined with erector spinae plane block did not enhance the postoperative quality of recovery at 48 and 72 h postoperatively. TRIAL REGISTRY NUMBER The number of this clinical trial registry is ChiCTR2100053230, date of registration: 16/11/ 2021).
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Affiliation(s)
- Yanxia Guo
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Jingting Wang
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Pingping Jiang
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Dan Wang
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Wenxi Fan
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Xiaolin Yang
- Department of Anaesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China.
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Impact of Bilateral Quadratus Lumborum Block Using Different Doses of Dexmedetomidine for Postoperative Analgesia in Laparoscopic Myomectomy: A Randomized Controlled Trial. Clin J Pain 2023; 39:85-90. [PMID: 36650604 DOI: 10.1097/ajp.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The optimal dosage of dexmedetomidine (DEX) for postoperative analgesia of quadratus lumborum block (QLB) after laparoscopic myomectomy is not clear. Our study evaluated the analgesic and adverse effects of different doses of locally administered DEX. MATERIALS AND METHODS Patients underwent laparoscopic myomectomy were enrolled in this randomized controlled trial. Transmuscular bilateral QLB was conducted postoperatively using local anesthetic plus different doses of DEX, as an adjuvant, per side. Numeric rating scales (NRS) of pain score and heart rate (HR) were assessed after performing QLB. Additional analgesics through patient-controlled analgesia pump, recovery time to first flatus, hospital stay, and other outcomes were also compared. RESULTS A total of 150 participants were randomly divided into 3 groups (DEX1 group: 0.1 μg/kg; DEX2 group: 0.3 μg/kg; DEX3 group: 0.5 μg/kg), 50 for each group. Compared with the DEX1 group, NRS pain scores were lower in groups DEX2 and DEX3 ( P <0.017) 20 minutes after QLB and the significance lasted for 24 hours. Patients in groups DEX2 and DEX3 needed fewer additional analgesics than the group DEX1 ( P <0.017). HR in groups DEX2 and DEX3 was lower than the group DEX1 10 minutes and 20 minutes after QLB, respectively ( P <0.017). Sixty minutes after QLB, HR in the DEX3 group was still lower than the other groups. More patients in the DEX3 group were found bradycardia. Satisfaction score of postoperative analgesia was higher in groups DEX2 and DEX3 than the DEX1 group ( P <0.017). DISCUSSION The results suggest that solution of DEX 0.3 μg/kg in ropivacaine 0.25% for QLB is recommended to relieve postoperative pain after laparoscopic myomectomy effectively and safely.
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Su Y, Chen C. Comment on: Effect of Dexmedetomidine as an adjuvant in quadratus lumborum block in patient undergoing caesarean section - A randomised controlled study. J Clin Anesth 2022; 83:110950. [PMID: 36244123 DOI: 10.1016/j.jclinane.2022.110950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ying Su
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, The Research Units of West China, Chinese Academy of Medical Science, Chengdu, Sichuan, China
| | - Chan Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, The Research Units of West China, Chinese Academy of Medical Science, Chengdu, Sichuan, China.
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11
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Kassim DY, Mahmoud HE, Fakhry DM, Mansour MA. Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study. BMC Anesthesiol 2022; 22:340. [PMID: 36344917 PMCID: PMC9639282 DOI: 10.1186/s12871-022-01877-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Background Transversus abdominis plane (TAP) block is beneficial for pain management after conducting abdominal surgery. Objective To compare the outcomes of dexmedetomidine and fentanyl, as adjuvants to bupivacaine, for ultrasound-guided TAP block analgesia among patients undergoing radical cystectomy for postoperative pain management. Methods This prospective, randomised, comparative study included a total of 60 patients, who underwent radical cystectomy. Participants were randomly divided into three categories with 20 subjects each; group B had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 2 ml normal saline; group BF had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg fentanyl dissolved in 2 ml normal saline and group BD had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg dexmedetomidine dissolved in 2 ml normal saline.The researchers recorded the time taken for first rescue analgesia, total analgesic dose in the first 24 h after surgery, patient satisfaction, sedation score, and postoperative complications. Results The time taken for first rescue analgesia was significantly lengthier in group (BD) (8.90 ± 2.47) than (BF) (6.50 ± 1.43) and (B) (4.40 ± 1.05) groups. The total nalbuphine consumption, during the first 24 h, was significantly lower in (BD) (0.15 ± 0.00) group compared to (BF) (0.20 ± 0.07) and (B) (0.24 ± 0.08) groups. Conclusion In comparison with fentanyl, as an adjuvant to bupivacaine, dexmedetomidine was found to be associated with prolonged postoperative analgesia, less postoperative pain scores and low opioid consumption. Trial registration This study was registered at Clinical Trials.gov on 23 March 2020 (registration number: NCT04318158).
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Singh N, Anandan V, Ahmad SR. Effect of Dexmedetomidine as an adjuvant in quadratus lumborum block in patient undergoing caesarean section - A randomised controlled study. J Clin Anesth 2022; 81:110892. [PMID: 35671598 DOI: 10.1016/j.jclinane.2022.110892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE This study was conducted to evaluate the effect of Dexmedetomidine as an adjuvant in quadratus lumborum block (QLB) for postoperative pain relief at rest in patients undergoing caesarean section (CS). The primary objective was to compare the time to the first request of rescue analgesia. Secondary objectives were to compare the amount of rescue analgesia, patient satisfaction, Numeric rating scale (NRS), and Ramsay sedation score (RSS) during the first 24 h. DESIGN A randomised, double-blinded study. SETTING The study was conducted at AIIMS Bhubaneswar from December 2019 to February 2021in the Operating Theatre complex (for the immediate postoperative follow-up) and in the Obstetric Ward (for follow-up at the later time points). PATIENTS A total of 70 patients were enrolled with singleton term pregnancies scheduled for CS under spinal anaesthesia after written informed consent. INTERVENTION Bilateral QLB was given in the recovery area. Group A received 30 ml of 0.25% Bupivacaine and group B received 30 ml 0.25% bupivacaine with Dexmedetomidine 1 μg/kg. They received inj. Paracetamol 15 mg/kg intravenously TDS and Inj. Tramadol 1 mg/kg as rescue analgesia (if Numeric rating scale (NRS) Score ≥ 4). We also compared the rescue analgesia in the first 24 h, patient satisfaction scores, Ramsay sedation score (RSS), and NRS scores at 2, 4, 6, 8, 12, 18, and 24 h. MAIN RESULTS The time to request the first rescue analgesia was significantly prolonged in group B [Mean ± SD (95% CI)] 880 ± 351 (720-1040) min. vs group A 439 ± 208 (368-510) min., p < 0.001). There was a significant decrease in the amount of rescue analgesia [(Inj. Tramadol (1 mg/ kg)] used in the group with dexmedetomidine [group B Mean ± SD (95% CI) (57 ± 18 (49-65) mg. vs group A - 81 ± 25 (73-90)] mg., p < 0.001]. A significant difference was seen in patient satisfaction scores and pain scores between the groups up to 18 h. (p < 0.05) but not in RSS. CONCLUSION Dexmedetomidine can be considered an effective adjuvant for QLB in CS in the absence of intrathecal morphine.
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Affiliation(s)
- Neha Singh
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India.
| | - Vishnu Anandan
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Suma Rabab Ahmad
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
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Abate SM, Mergia G, Nega S, Basu B, Tadesse M. Efficacy and safety of wound infiltration modalities for postoperative pain management after cesarean section: a systematic review and network meta-analysis protocol. Syst Rev 2022; 11:194. [PMID: 36071535 PMCID: PMC9450460 DOI: 10.1186/s13643-022-02068-2] [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: 12/06/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pain after a cesarean section has negative consequences for the mother during the postoperative period. Over the years, various postoperative pain management strategies have been used following cesarean section. Opioid-based analgesics and landmark approaches have negative side effects, while ultrasound-based regional analgesia necessitates resources and experience, but various wound infiltration adjuvants are innovative with few side effects and are simple to use. The efficacy and safety of each adjuvant, however, are unknown and require further investigation. OBJECTIVE This network meta-analysis is intended to provide the most effective wound infiltration drugs for postoperative management after cesarean section. METHOD A comprehensive search will be conducted in PubMed/MEDLINE, Cochrane Library, Science Direct, CINHAL, and LILACS without date and language restrictions. All randomized trials comparing the effectiveness of wound infiltration drugs for postoperative pain management after cesarean section will be included. Data extraction will be conducted independently by two authors. The quality of studies will be evaluated using the Cochrane risk of bias tool, and the overall quality of the evidence will be determined by GRADEpro software. DISCUSSION The rate of postoperative acute and chronic pain is very high which has a huge impact on the mother, family, healthcare practitioners, and healthcare delivery. It is a basic human right to give every patient with postoperative pain treatment that is realistic in terms of resources, technique, cost, and adverse event profile. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021268774.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
| | - Getachew Mergia
- Departemnt of Obstetrics and Gynecology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Solomon Nega
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Moges Tadesse
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Yi-han W, Rong T, Jun L, Min W, Yan Z, Yi L, Jie-ting L, Sheng-hui H. Dexmedetomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:235. [PMID: 35277166 PMCID: PMC8915521 DOI: 10.1186/s12891-022-05198-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Due to lumbar spinal surgery is frequently accompanied with moderate-to-severe postoperative pain, it is necessary to find an effective postoperative analgesia for patients with this surgery. This study aimed to observe the analgesic effect of dexmedetomidine combined with ropivacaine erector spinae plane block (ESPB) used in posterior lumbar spine surgery. Methods In this clinical trial, patients undergoing posterior lumbar spine surgery were recruited and randomly divided into two groups: intervention and control. The intervention group (Group E) received 0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for ESPB; the control group (Group C) received 20 ml ropivacaine 0.375% for ESPB. US-guided ESPB was performed preoperatively in all patients. Demographics, anesthesia time, surgery time, and ASA grade from the participants were recorded at baseline. The primary clinical outcome measures were 2-, 4-, 8-, 12-, 24-and 48-h visual analog scale (VAS) pain scores after surgery at rest and movement state. Other end points included opioid consumption, number of PCIA presses, flurbiprofen-axetil consumption, quality of recovery and pain management after surgery. Results One hundred twenty patients were enrolled in the study (mean [SD] ages: Group E, 54.77 [8.61] years old; Group C,56.40 [7.87] years old; P = 0.280). The mean anesthesia time was 152.55 (15.37) min in Group E and 152.60 (16.47) min in Group C (P = 0.986). Additionally, the surgery time was 141.70 (15.71) min in Group E compared to 141.48 (17.13) min in Group C (P = 0.943). In addition, we found that the VAS pain scores in the resting state during the postoperative period at 8–48 h were lower in Group E than in Group C. However, the VAS pain scores in the active state were lower in Group E at 12–48 h (P < 0.05). More importantly, the consumption of opioids and flurbiprofen-axetil after surgery was also lower in Group E (P < 0.05). Subsequently, we administered questionnaires on the quality of recovery and pain management after surgery that were positively correlated with the postoperative analgesic effect. It was worth affirming that the QoR-15 scores and APS-POQ-R questionnaire results were different between the two groups, further confirming that the combination of drugs not only could obtain an ideal analgesic effect but also had no obvious adverse reactions (P < 0.05). Conclusions All the findings suggested that dexmedetomidine could significantly relieve postoperative pain and reduce the consumption of opioids in patients undergoing posterior lumbar spine surgery without obvious adverse reactions as a local anesthetic adjuvant. Further studies with larger sample sizes and different drug dosages may be useful in understanding the potential clinical benefits of dexmedetomidine.
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López-Ruiz C, Orjuela JC, Rojas-Gualdrón DF, Jimenez-Arango M, Ríos JFDL, Vásquez-Trespalacios EM, Vargas C. Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:55-66. [PMID: 35092960 PMCID: PMC9948299 DOI: 10.1055/s-0041-1740595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. DATA SOURCES We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. METHOD OF STUDY SELECTION Two researchers independently evaluated the eligibility of the selected articles. TABULATION, INTEGRATION, AND RESULTS Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2 = 68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2 = 69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2 = 80%); and incidence of nausea and vomiting with a difference of 95%CI = - 0.11 (- 0.215-0.006) in favor of TAP. CONCLUSION With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. CLINICAL TRIAL NUMBER AND REGISTRY PROSPERO ID - CRD42018103573.
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Affiliation(s)
- Claudia López-Ruiz
- Department of Gynecology and Obstetrics, Clínica del Prado, Medellín, Colombia.,School of Graduate Studies, School of Medicine, CES University, Medellín, Colombia
| | | | | | | | | | | | - Claudia Vargas
- American Association of Gynecologic Laparoscopists, Medellín, Colombia
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Zhang L, Hao LJ, Hou XL, Wu YL, Jing LS, Sun RN. Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy. Front Psychol 2021; 12:727250. [PMID: 34707538 PMCID: PMC8542785 DOI: 10.3389/fpsyg.2021.727250] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/10/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management. Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded. Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation. Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.
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Affiliation(s)
- Lin Zhang
- Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Li-Jun Hao
- Department of Pain, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xiao-Lai Hou
- Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ya-Ling Wu
- Department of Gynecology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Lu-Shi Jing
- Department of Psychology, Chengdu Medical College, Chengdu, China
| | - Ruo-Nan Sun
- Department of Psychology, Chengdu Medical College, Chengdu, 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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Bozorgi H, Zamani M, Motaghi E, Eslami M. Dexmedetomidine as an Analgesic Agent with Neuroprotective Properties: Experimental and Clinical Aspects. J Pain Palliat Care Pharmacother 2021; 35:215-225. [PMID: 34100671 DOI: 10.1080/15360288.2021.1914280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dexmedetomidine (Dexdor or Precedex®) is considered as a sedative agent which is widely used as an adjuvant in general anesthesia and critical care practice. There is extensive evidence indicating its neuroprotective properties especially in various ischemic and hemorrhagic brain injury models of animals. Clinical trials have shown that dexmedetomidine (DEX) can improve the outcome of intensive care unit (ICU) patients. Also, DEX is appropriate as a non-opioid analgesic therapy whenever minimizing opioid-related side effects is necessary. The present article reviews the recent advances in the use of DEX as a neuroprotective agent in both animal and human studies including newest findings about the mechanism of the drug as well as analgesic efficacy of this drug at all perioperative stages. In spite of the beneficial effects of the drug on the nervous system, there are potential adverse effects, such as hypotension and bradycardia, which can be treated pharmacologically and must be taken into consideration by clinicians.
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Affiliation(s)
- Hooman Bozorgi
- Hooman Bozorgi is with the Department of Pharmacology, Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Melika Zamani is with the Department of Pharmacology, School of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran/Panzdah-e-Khordad Hospital, Mahdishahr, Iran. Ehsan Motaghi is with the Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Majid Eslami is with Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Melika Zamani
- Hooman Bozorgi is with the Department of Pharmacology, Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Melika Zamani is with the Department of Pharmacology, School of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran/Panzdah-e-Khordad Hospital, Mahdishahr, Iran. Ehsan Motaghi is with the Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Majid Eslami is with Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ehsan Motaghi
- Hooman Bozorgi is with the Department of Pharmacology, Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Melika Zamani is with the Department of Pharmacology, School of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran/Panzdah-e-Khordad Hospital, Mahdishahr, Iran. Ehsan Motaghi is with the Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Majid Eslami is with Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Eslami
- Hooman Bozorgi is with the Department of Pharmacology, Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Melika Zamani is with the Department of Pharmacology, School of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran/Panzdah-e-Khordad Hospital, Mahdishahr, Iran. Ehsan Motaghi is with the Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Majid Eslami is with Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Talebi G, Moayeri H, Rahmani K, Nasseri K. Comparison of Three Different Doses of Dexmedetomidine Added to Bupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block; A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e113778. [PMID: 34336630 PMCID: PMC8314081 DOI: 10.5812/aapm.113778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Adding dexmedetomidine to bupivacaine has been shown to prolong the analgesic effects of the transversus abdominis plane (TAP) block. However, the optimal dose of this adjuvant drug is unclear. Objectives Identifying optimal doses of dexmedetomidine added to bupivacaine in the TAP block. Methods In this randomized controlled trial, 86 patients candidate for elective open inguinal herniorrhaphy under spinal anesthesia were divided randomly into three groups; low (L), medium (M), and high (H) dose of dexmedetomidine, that finally 80 cases ended the study and were analyzed. At the end of the surgery, the patients underwent ultrasound-guided TAP block. In all patients of the three groups, the analgesic base of the block was 20 mL bupivacaine 0.125% that was supplemented with 0.5, 1, or 1.5 µ/kg of dexmedetomidine in groups L, M, and H, respectively. Results The maximum duration of the block was 4 hours in group L and 8 hours in groups M and H. None of the patients needed to receive analgesic at 0, 2, and 24 hours after the block. The dose of analgesic required in the first 8 hours of the block in groups M and H was less than in group L (P < 0.02). Patients in groups H and M were more satisfied with the block (P < 0.01) and experienced less pain compared with group L (P < 0.01). Drowsiness and sedation were observed in patients up to 4 hours after the TAP block, which was dependent on the dexmedetomidine dose (P < 0.01). Conclusions Based on our results, the optimal dose of supplemental dexmedetomidine could be 1 µ/kg in the TAP block.
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Affiliation(s)
- Gilda Talebi
- Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hassan Moayeri
- Department of Surgery, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Karim Nasseri
- Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Corresponding Author: Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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20
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Garg K, Bhardwaj N, Yaddanapudi S, Sen IM, Mathew PJ, Kanojia RP. Efficacy of dexmedetomidine as an adjunct to ropivacaine in transversus abdominis plane block for paediatric laparoscopic surgeries: A double-blinded randomised trial. Indian J Anaesth 2021; 65:S27-S33. [PMID: 33814587 PMCID: PMC7993041 DOI: 10.4103/ija.ija_1207_20] [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: 09/29/2020] [Revised: 10/19/2020] [Accepted: 12/25/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims α2 agonists have been utilised in regional blocks, but very little data is available for their use in transversus abdominis plane (TAP) block in paediatric laparoscopic (LAP) surgeries. This study investigated the analgesic effect of ropivacaine alone versus its combination with dexmedetomidine for TAP block in children undergoing LAP surgery. METHODS A randomised, double-blind trial was conducted in 50 American Society of Anesthesiologists (ASA) 1 and 2 children of 2-8 years undergoing LAP abdominal surgery. Children were randomised to receive a total volume of 0.5 ml/kg of 0.2% ropivacaine (LA group) or 0.2% ropivacaine with 1 μg/kg dexmedetomidine (LAD group) for performing ultrasound-guided bilateral TAP block postoperatively (PO). Patients were monitored PO for vital signs, pain, sedation, time to first rescue analgesic and total analgesic consumption for 24 h. Time to first rescue analgesic was expressed as mean ± standard deviation (SD) and analysed using Kaplan-Meier survival analysis. Pain and sedation scores were expressed as median [interquartile range (IQR)] and analysed using Mann-Whitney U test. Results First rescue analgesic demand was significantly longer (P = 0.001) in LAD (474.8 min) versus LA group (240.9 min) but total analgesics consumption in first 24 h was comparable. Pain scores were significantly lower (P < 0.05) in LAD compared to LA group at all times PO. Each group had comparable but significantly lower sedation scores up to 24 h PO. Conclusion Addition of dexmedetomidine to ropivacaine in TAP block prolongs the time to first analgesic requirement without a difference in the total analgesic consumption.
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Affiliation(s)
- Kashish Garg
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Indu M Sen
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Preethy J Mathew
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Ravi P Kanojia
- Paediatric Surgery, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
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21
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Ultrasound-guided transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy: A retrospective study. North Clin Istanb 2021; 8:88-94. [PMID: 33623879 PMCID: PMC7881418 DOI: 10.14744/nci.2020.84665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/29/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE: This study aimed to investigate the effects on postoperative pain of ketamine and dexmedetomidine addition to bupivacaine in a transversus abdominis plane (TAP) block in laparoscopic cholecystectomy. METHODS: A retrospective study was conducted patients who underwent ultrasound-guided TAP block in laparoscopic cholecystectomy. The patients were divided into three groups: Group BD (Bupivacaine+Dexmedetomidine), Group BK (Bupivacaine+Ketamine), and Group B (Bupivacaine). Our primary outcomes were pain scores with Visual Analogue Scale (VAS), postoperative first analgesic time and tramadol consumption in 24 hours postoperatively. Secondary outcomes were intraoperative hemodynamic changes, rescue analgesic requirement and side effects. RESULTS: The first analgesic administration time was significantly shorter in Group B and significantly longer in Group BD than the other two groups. Pain score at rest in Group B at 0th hours was significantly higher than that of Group BD and VAS pain score Group BD at 2nd hours was significantly lower than the other two groups. There was no significant difference between the groups regarding tramadol consumption and the requirement of rescue analgesics. CONCLUSION: Dexmedetomidine and ketamine can be added to the bupivacaine for the TAP block without major side-effects. The combination of dexmedetomidine and bupivacaine provides better analgesia in the first postoperative 2nd hour than other groups and hence extends the time to the first analgesic demand.
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Dexmedetomidine as an Adjunct for Regional Anesthetic Nerve Blocks. Curr Pain Headache Rep 2021; 25:8. [PMID: 33533982 DOI: 10.1007/s11916-020-00926-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This article will review current evidence related to the use of dexmedetomidine as an adjuvant for regional anesthesia. RECENT FINDINGS Adjuvants, frequently used during regional anesthesia, act synergistically with local anesthetics thus enhancing the quality of regional anesthesia while minimizing adverse effects. These adjuvants may be administered via different routes including topical, perineural, neuraxial, and systemic. Recent studies indicate that dexmedetomidine prolongs the duration of intravenous regional anesthesia, peripheral nerve blocks, and spinal analgesia. Controversy regarding potential neurotoxicity of perineural dexmedetomidine in patients with diabetic neuropathy requires further evaluation.
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Joseph B, Zachariah SK, Abraham SP. The comparison of effects of fentanyl and dexmedetomidine as adjuvants to ropivacaine for ultrasound-guided transversus abdominis plane block for postoperative pain in cesarean section under spinal anesthesia -A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2021; 36:377-380. [PMID: 33487906 PMCID: PMC7812960 DOI: 10.4103/joacp.joacp_313_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/27/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022] Open
Abstract
Background and Aims: Transversus abdominis plane (TAP) block has been effectively used for anterior abdominal wall analgesia. The aim of the study was to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to ropivacaine in TAP block under ultrasound-guidance after lower segment cesarean section in a randomized controlled trial. Material and Methods: Sixty-four women of American Society of Anaesthesiologists (ASA) physical status II coming for cesarean sections were randomized to receive TAP blocks on each side of the abdomen using the local anesthetic drug 20 ml of 0.5% ropivacaine with either fentanyl 25 mcg or dexmedetomidine 25 mcg. A ten point numerical pain score was done at baseline, at 1 h and then at intervals of 4 h postoperatively. The hemodynamic parameters such as heart rate, blood pressure, and pulse oximetry were also monitored as above. The time to first analgesia demand from the time of the block and the total analgesic consumption were recorded. The statistical analysis was done by Mann-Whitney U test and the analgesics consumption by using Chi-square test with R software. Results: Our primary end-point was to assess the duration of analgesia produced by fentanyl added to ropivacaine for ultrasound-guided TAP block, which were 125 min with Q1–Q3 as 110–180 and dexmedetomidine 130 min with Q1–Q3 as 105–161 (P value = 0.47). The amount of analgesics used in the postoperative period in both the groups were analyzed using the Chi-square test not found to have any significant difference between both the groups (P-value = 0.512). Conclusion: Fentanyl and dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided TAP block were equally effective in both prolongation of analgesia and reducing the total consumption of analgesics.
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Affiliation(s)
- Bincy Joseph
- Department of Anaesthesia, MOSC Medical College, Kolenchery, Kerala, India
| | | | - Saramma P Abraham
- Department of Anaesthesia, MOSC Medical College, Kolenchery, Kerala, India
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Siddiqui KM, Ali MA, Salim B. Transversus abdominis plane block as a sole anesthetic technique for open appendectomy in patient with Treacher Collins syndrome: a case report. J Surg Case Rep 2020; 2020:rjaa431. [PMID: 33343860 PMCID: PMC7732257 DOI: 10.1093/jscr/rjaa431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with Treacher Collins syndrome (TCS) present serious challenges to anesthetist in securing of airway; upper airway obstruction and difficult tracheal intubation are considered complex entity in these patients. This case report describes the significance of transversus abdominis plane (TAP) block as a sole anesthetic choice in appendectomy where airway management can be avoided. A 17-year-old boy, known case of TCS, presented with acute appendicitis underwent emergency laparotomy. Surgery was successfully performed by TAP block with dexmedetomidine infusion. Open appendectomy can be performed successfully in certain circumstances under TAP block with adjunctive use of dexmedetomidine infusion where airway handling is avoided. Further studies are warranted to distinct its use as sole anesthetic choice in lower abdominal surgeries.
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Affiliation(s)
| | - Muhammad Asghar Ali
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Bushra Salim
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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Madangopal RM, Dang A, Aggarwal M, Kumar J. A comparative evaluation of different doses of dexmedetomidine as an adjuvant to bupivacaine in transversus abdominis plane block for postoperative analgesia in unilateral inguinal hernioplasty. J Anaesthesiol Clin Pharmacol 2020; 36:398-406. [PMID: 33487910 PMCID: PMC7812963 DOI: 10.4103/joacp.joacp_26_19] [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: 01/31/2020] [Revised: 09/04/2020] [Accepted: 10/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims The present study is designed to evaluate addition of two different doses of dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) as an adjuvant to bupivacaine in transversus abdominis plane block for post-operative analgesia in patients undergoing unilateral inguinal hernioplasty. Material and Methods A total of 90 patients scheduled to undergo elective unilateral open inguinal hernioplasty were divided into three groups in a randomized triple blind way. In group B (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25% bupivacaine and 2 ml of normal saline; in group BD1 (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25% bupivacaine and dexmedetomidine 0.25 mcg/kg dissolved in 2 ml of normal saline; while in group BD2 (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25% bupivacaine and dexmedetomidine 0.5 mcg/kg dissolved in 2 ml of normal saline. Results Time to first analgesia was significantly prolonged in group BD2 (874.48 ± 118.28 minutes) as compared to BD1 (536.5 ± 60.35 minutes) and B (341.5 ± 46.22 minutes) (P < 0.0001). Total consumption of diclofenac was also reduced in BD2 (80.17 ± 19.34 mg) as compared with B (150 ± 0 mg) and BD1 (147.5 ± 13.69 mg) (P < 0.001). Patients in dexmedetomidine group were more sedated at 1-hour (P < 0.05). None of our patients required any intervention for hemodynamic changes which were significantly more in dexmedetomidine group. Conclusion Dexmedetomidine in a dose of 0.5 mcg/kg is better than dose of 0.25 mcg/kg as an adjuvant to 0.25% bupivacaine in transversus abdominis plane block for post-operative pain relief in unilateral inguinal hernioplasty. However, it causes mores sedation and hemodynamic changes.
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Affiliation(s)
- Rathi Mitesh Madangopal
- Department of Anaesthesiology and Critical Care, NDMC Medical College and Associated Hindu-Rao Hospital, Delhi, India
| | - Aashish Dang
- Department of Anaesthesiology and Critical Care, NDMC Medical College and Associated Hindu-Rao Hospital, Delhi, India
| | - Megha Aggarwal
- Department of Anaesthesiology and Critical Care, NDMC Medical College and Associated Hindu-Rao Hospital, Delhi, India
| | - Jay Kumar
- Department of Anaesthesiology and Critical Care, NDMC Medical College and Associated Hindu-Rao Hospital, Delhi, India
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Abdellatif AA, Kasem AA, Bestarous JN, Toaima TN, Ali MM, Shokri H. Efficacy of dexmedetomidine as an adjuvant to Quadratus lumborum block for pediatrics undergoing laparoscopic pyeloplasty. A prospective randomized double blinded study. Minerva Anestesiol 2020; 86:1031-1038. [DOI: 10.23736/s0375-9393.20.14298-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Neethirajan SGR, Kurada S, Parameswari A. Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Transverse Abdominis plane Block for Laparoscopic appendicectomy: A Randomised Controlled Study. Turk J Anaesthesiol Reanim 2019; 48:364-370. [PMID: 33103140 PMCID: PMC7556648 DOI: 10.5152/tjar.2019.67689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Dexmedetomidine is an alpha 2-adrenergic agonist that prolongs analgesia as an adjuvant when added in neuraxial and peripheral nerve blocks. The aim of the present study was to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound (USG)-guided transverse abdominis plane (TAP) block for postoperative analgesia in laparoscopic appendicectomy. Methods A total of 60 American Society of Anesthesiologists I and II adult patients aged between 16 and 60 years planned for laparoscopic appendicectomy were randomised into two groups (A and B). Group A patients received 20 mL of 0.125% bupivacaine+1 μg kg−1 dexmedetomidine, whereas group B patients received 20 mL of 0.125% bupivacaine alone on both sides at the time of USG-guided TAP block. Haemodynamic variables, pain scores, sedation scores, time to first dose of rescue analgesic and side effects, if any, were assessed and compared between the groups. Results Demographic and operative characteristics were comparable in both groups. The mean duration of analgesia was more in group A (7.33 h) than in group B (4.8 h). The requirement of rescue analgesics was more in group B (80%) than in group A (56.7%). The sedation and pain scores at 2, 4 and 6 h were better in group A than in group B (p<0.05). The heart rate, systolic blood pressure and diastolic blood pressure were lower in group A during the postoperative period than in group B. Conclusion The addition of dexmedetomidine as an adjuvant to bupivacaine in TAP block provides prolonged postoperative analgesia and better pain control with reduced need for rescue analgesics than bupivacaine alone in patients undergoing laparoscopic appendicectomy.
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Affiliation(s)
| | - Santoshi Kurada
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
| | - Aruna Parameswari
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
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Gao Z, Xiao Y, Wang Q, Li Y. Comparison of dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:668. [PMID: 31930069 DOI: 10.21037/atm.2019.10.74] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Adding an adjuvant, such as dexmedetomidine or dexamethasone, to a nerve block improves its quality and reduces perioperative opioid consumption. We aimed to compare the effect of dexmedetomidine and dexamethasone as an adjuvant for the erector spinae plane block (ESPB) to control postoperative pain after video-assisted thoracoscopic lobectomy surgery (VATLS). Methods Ninety patients, aged 20-65 years who were scheduled to undergo VATLS were enrolled in this trial. The visual analogue scale (VAS) score changes at various time points [waking up in post-anesthesia care unit (PACU) and 2, 4, 6, 8, 12, 24, 48, 72 h after surgery], duration of sensory block, first request to use the patient controlled analgesia (PCA) device, total PCA use, postoperative nausea and vomiting (PONV), rate of rescue analgesia use, and post-surgical hospital stay were recorded. Results VAS score was lower in the ropivacaine with dexmedetomidine (RM) group at wake up and at postoperative 2, 4, 12, and 24 h. The median duration of sensory blockade was significantly longer in the RM group (P=0.001). First request to use the PCA machine in the RM group was prolonged significantly compared with that in the ropivacaine alone (R) group and ropivacaine with dexamethasone (RS) group (P<0.001). Total PCA use, post-surgical hospital stay, and rate of rescue analgesia use in The RM group were reduced significantly compared with those in the R and RS groups. Conclusions Using dexmedetomidine (1 µg/kg), instead of dexamethasone (10 mg), as an adjuvant of ESPB with ropivacaine, prolonged sensory block duration, provided effective acute pain control, and required lesser rescue analgesia and shorter hospital stays.
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Affiliation(s)
- Zhixin Gao
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yimin Xiao
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Qing Wang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yuanhai Li
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Abstract
Abstract
In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.
Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.
Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.
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Azemati S, Pourali A, Aghazadeh S. Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial. Korean J Anesthesiol 2019; 73:212-218. [PMID: 31636243 PMCID: PMC7280894 DOI: 10.4097/kja.19111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023] Open
Abstract
Background Postoperative pain is a major problem, especially in children, as their tolerance level is lower and several drugs are contraindicated in childhood. This study aimed to compare the effect of dexmedetomidine added to local infiltration of bupivacaine for postoperative pain relief in children undergoing inguinal herniorrhaphy. Methods This double-blind, randomized clinical trial included 60 children aged 6–72 months undergoing unilateral herniorrhaphy at selected hospitals in Shiraz, Iran, randomly allocated into two groups, 30 in each group. One group received 1 µg/kg dexmedetomidine plus local infiltration of 0.2 ml/kg bupivacaine 0.5% at the incision site before surgery (BD), and the other group received bupivacaine and normal saline (BO). Analgesic requirements, emergence time, and nausea/vomiting, postoperative pain and sedation scores were assessed for 4 h after the operation. Heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SaO2) were recorded at baseline, and at 10 and 20 min after injection. Results Eighty percent were boy in each group; mean age was 22.75 ± 18.63 months. SaO2 and SBP were not different between the groups, while HR was significantly lower in the Group BD at 10 and 20 min after injection (P < 0.05). Group BD had a lower pain score at 1 and 2 h after the operation, a higher sedation score at the first three time intervals, and longer emergence time than Group BO (all P < 0.001). Group BD had a lower pain score at 1 and 2 h after the operation (P < 0.001, P < 0.047 respectively). Conclusions Addition of dexmedetomidine to local infiltration of bupivacaine in children undergoing herniorrhaphy significantly reduced postoperative pain and increased sedation.
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Affiliation(s)
- Simin Azemati
- Department of Anesthesiology and Intensive Care Unit, Medical College, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Pourali
- Department of Anesthesiology and Intensive Care Unit, Medical College, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Aghazadeh
- Department of Anesthesiology and Intensive Care Unit, Medical College, Shiraz University of Medical Sciences, Shiraz, Iran
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El Kenany S, Elshehawi ME, Farid AM, Eid MI. Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study. Anesth Essays Res 2019; 13:522-527. [PMID: 31602072 PMCID: PMC6775853 DOI: 10.4103/aer.aer_95_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Aim: Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects. Settings and Design: A prospective, randomized, controlled double-blind trial that was carried out at a university hospital. Patients and Methods: Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded. Statistical Analysis: Student's t-test, Mann–Whitney U-test, and Chi-square test were used. Results: Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10–19.50) mg compared to 25 (17.50–37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus. Conclusions: Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.
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Affiliation(s)
- Samah El Kenany
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Eslam Elshehawi
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Mohamed Farid
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ibrahem Eid
- Department of Obstetrics and Gynaecology, College of Medicine, Mansoura University, Mansoura, Egypt
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Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block. Clin J Pain 2019; 35:855-857. [DOI: 10.1097/ajp.0000000000000744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Saldanha A, Martini R, Basseto JE, do Carmo MPW, Freitag FAV, Lange RR, Duque JC. Use of transversus abdominis plane block in chinchillas (Chinchilla lanigera). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Effect of Adding Dexmedetomidine to Local Anesthetic Agents for Transversus Abdominis Plane Block. Clin J Pain 2019; 35:844-854. [DOI: 10.1097/ajp.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Moulder JK, Boone JD, Buehler JM, Louie M. Opioid Use in the Postoperative Arena: Global Reduction in Opioids After Surgery Through Enhanced Recovery and Gynecologic Surgery. Clin Obstet Gynecol 2019; 62:67-86. [PMID: 30407228 DOI: 10.1097/grf.0000000000000410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Enhanced recovery programs aim to reduce surgical stress to improve the patient perioperative experience. Through a combination of multimodal analgesia and maintaining a physiological state, postoperative recovery is improved. Many analgesic adjuncts are available that improve postoperative pain control and limit opioid analgesia requirements. Adjuncts are often used in combination, but different interventions may be incorporated for patient-specific and procedure-specific needs. Postoperative pain control can be optimized by continuing nonopioid adjuncts, and prescribing opioid analgesia to address breakthrough pain. Prescribing practices should balance optimizing pain relief, minimizing the risk of chronic pain, while limiting the potential for opioid misuse.
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Affiliation(s)
| | | | - Jason M Buehler
- Anesthesiology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee
| | - Michelle Louie
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Gupta D, Haldar R. The unending pursuit for subduing postoperative pain after cesarean section: Current gradation of transversus abdominis plane block. J Anaesthesiol Clin Pharmacol 2019; 35:145-146. [PMID: 31303698 PMCID: PMC6598576 DOI: 10.4103/joacp.joacp_304_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Devendra Gupta
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sun Q, Liu S, Wu H, Ma H, Liu W, Fang M, Liu K, Pan Z. Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block: A Systematic Review and Meta-analysis. Clin J Pain 2019; 35:375-384. [PMID: 30475260 PMCID: PMC6410974 DOI: 10.1097/ajp.0000000000000671] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 11/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery. METHODS Electronic databases, including PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library, were conducted to collect the randomized controlled trials (RCTs) from inception to March 2018. RCTs investigating the impact of adding DEX to local anesthetics for TAP blocks were included in this analysis. Pain scores (at rest and movement), opioid consumption, the duration of the TAP block and the common adverse effects were analyzed. RESULTS Twenty published trials including 1212 patients met the inclusion criteria. The addition of DEX significantly reduced pain scores 8 hours postoperatively at rest (WMD, -0.78; 95% CI, -1.27 to -0.30; P=0.001), 4 hours postoperatively on movement (WMD, -1.13; 95% CI, -1.65 to -0.60; P<0.001), and opioid consumption (WMD, -13.71; 95% CI, -17.83 to -9.60; P<0.001) when compared with control group. Furthermore, perineural DEX significantly prolonged the duration of the TAP block (WMD, 3.33; 95% CI, 2.85 to 3.82; P<0.001). It did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, somnolence, or pruritus. CONCLUSIONS DEX is a potential anesthetic adjuvant that can facilitate better postoperative analgesia, reduce postoperative analgesic requirements, and prolong the local anesthetic effect when administered in TAP blocks.
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Affiliation(s)
| | | | | | - He Ma
- Department of Anesthesiology
| | - Wei Liu
- Department of Anesthesiology
| | | | - Kexiang Liu
- Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
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Biçer C, Ünalan EN, Aksu R, Önal Ö, Güneş I. Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 30665671 PMCID: PMC9391857 DOI: 10.1016/j.bjane.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background and objective Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method 93 ASA I–II patients aged 18–65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 μg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.
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Affiliation(s)
- Cihangir Biçer
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
| | - Esra Nur Ünalan
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
| | - Recep Aksu
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia.
| | - Ömer Önal
- Erciyes University, Medical Faculty, Thoracic Surgery Department, Kayseri, Turquia
| | - Işın Güneş
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
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Biçer C, Ünalan EN, Aksu R, Önal Ö, Güneş I. [Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy]. Rev Bras Anestesiol 2019; 69:144-151. [PMID: 30665671 DOI: 10.1016/j.bjan.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/04/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. MATERIAL AND METHOD 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20mL 0.5% bupivacaine injection in Group B (n=31) and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. RESULTS No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p=0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p<0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p<0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p<0.05). CONCLUSION The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.
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Affiliation(s)
- Cihangir Biçer
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
| | - Esra Nur Ünalan
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
| | - Recep Aksu
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia.
| | - Ömer Önal
- Erciyes University, Medical Faculty, Thoracic Surgery Department, Kayseri, Turquia
| | - Işın Güneş
- Erciyes University, Medical Faculty, Anesthesiology and Reanimation Department, Kayseri, Turquia
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Varshney A, Prabhu M, Periyadka B, Nanjundegowda DC, Rao A. Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery. J Anaesthesiol Clin Pharmacol 2019; 35:161-164. [PMID: 31303702 PMCID: PMC6598575 DOI: 10.4103/joacp.joacp_372_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Transverse abdominus plane (TAP) block provides good quality analgesia with minimal side effects. Addition of adjuvant like dexmedetomidine to the local anesthetics has been shown to prolong the action of the block in earlier studies. In this prospective randomised study TAP block with levobupivacane with or without dexmedetomidine was compared with control group for post-operative analgesia following cesarean delivery. Material and Methods: Ninety healthy women undergoing cesarean delivery under spinal anesthesia were randomized into three groups (GroupC, GroupL and Group LD). And following this Group L received ultrasound guided bilateral TAP block with 20 ml 0.25% levobupivacaine on each side, while Group LD received TAP block with same volume of levobupivacaine with 1μg/kg of dexmedetomidine. Group C, the control group did not receive TAP block. Postoperatively, time for first request for rescue analgesia and the number of women requesting analgesia in 6 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on movement for the first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. Results: Time for first rescue analgesia was significantly longer and patient satisfaction scores were significantly higher in patients who received TAP block (Groups LD and L) as compared to control (Group C). Pain scores were also lower in the TAP block groups compared to control group. Among the women who received TAP block, those with dexmedetomidine group (Group LD) asked for rescue analgesia significantly later compared to group L. Patient satisfaction score was highest in the Group LD compared to Group L which in turn was better than control group. There were no significant differences in the observed side effects. Conclusion: Bilateral TAP block with 0.25% levobupivacaine provides good quality analgesia for early postoperative period. Adding dexmedetomidine further improves pain control and gives higher patient satisfaction without any added side effects.
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Affiliation(s)
- Aman Varshney
- Department of Anaesthesiology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manjunath Prabhu
- Department of Anaesthesiology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavya Periyadka
- Department of Anaesthesiology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Divyashri C Nanjundegowda
- Department of Anaesthesiology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amrut Rao
- Department of Anaesthesiology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Chen Q, Liu X, Zhong X, Yang B. Addition of dexmedetomidine or fentanyl to ropivacaine for transversus abdominis plane block: evaluation of effect on postoperative pain and quality of recovery in gynecological surgery. J Pain Res 2018; 11:2897-2903. [PMID: 30532583 PMCID: PMC6247967 DOI: 10.2147/jpr.s178516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Transversus abdominis plane (TAP) block is reportedly a preferable technique for reducing postoperative pain in abdominal surgeries. The aim of this study was to compare the analgesic efficacy and recovery quality after gynecological surgery by adding dexmedetomidine or fentanyl into an ultrasound-guided TAP block. Methods We randomly assigned 100 elective gynecological patients into four groups (TAP, TAP-DEX, TAP-FEN, and control, n=25 in each). TAP blocks were performed postoperatively. The control group received patient-controlled intravenous analgesia (PCIA), the TAP group received TAP blocks with 0.375% ropivacaine, the TAP-DEX group received 0.375% ropivacaine with dexmedetomidine 1 µg/kg, and the TAP-FEN group received 0.375% ropivacaine with fentanyl 1 µg/kg. The primary outcomes were the first request time for PCIA bolus and quality of postoperative recovery assessed using the QoR-40 questionnaire 2 days after surgery. The secondary outcomes were the visual analog scale (VAS) scores at rest across the different time intervals, the total number of PCIA boluses required in 24 and 48 hours postoperatively, and associated complications. Results The first request time for PCIA was significantly longer in the TAP-DEX than in the TAP, TAP-FEN, and control groups (9.86±0.77, 7.86±0.56, 8.79±0.55, and 1.56±0.65 hours, respectively; P<0.01). The QoR-40 scores were highest in the TAP-DEX group (P<0.05). The mean PCIA bolus consumption in the first 24–48 hours was lowest in TAP-DEX group. VAS showed significant differences between TAP-DEX and TAP-FEN groups only at 6 hours (P<0.01). Conclusion The use of dexmedetomidine as an adjuvant to TAP blocks could facilitate postoperative analgesia and improve the quality of recovery without increasing related complications.
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Affiliation(s)
- Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China,
| | - Xing Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China,
| | - Xuejiao Zhong
- 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,
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Dai C, Zhang K, Huang J. The Efficacy of Transversus Abdominis Plane Block for Abdominal Hysterectomy Post-operative Analgesia. Cureus 2018; 10:e3131. [PMID: 30345190 PMCID: PMC6181248 DOI: 10.7759/cureus.3131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction/background Abdominal hysterectomy is an open surgical procedure associated with considerable post-operative pain. Narcotics are often required during patient recovery but can result in adverse side effects. Transversus abdominis plane block (TAP block) is a regional anesthetic technique that is found to be an effective post-operative analgesia for many types of abdominal surgeries, including abdominal hysterectomies. However recent literature shows contradicting results regarding TAP block's analgesic effect on recovery from abdominal hysterectomies. This study investigated the efficacy of TAP block to reduce narcotic consumption and improve pain scores in abdominal hysterectomy patients. Methods A single-center retrospective cohort study was performed. The inclusion criteria was patients who underwent abdominal hysterectomy at Winnie Palmer Hospital for Women & Babies (WPH) between January 12, 2015 and December 31, 2015. Exclusion criteria were patients who received a second surgery within the same hospitalization, experienced an in-hospital mortality event, received hysterectomy for known malignancy, stayed in the hospital less than 24 hours, and whose charts contained missing data points. Data collected were: age, weight, height, body mass index (BMI), length of hospital stay, total narcotic consumption (intra-operation, in the post-anesthesia care unit (PACU), first 24 hours after admittance, during entire hospital stay, total patient-controlled analgesia (PCA) quantity, and total oral narcotics quantity. All narcotics were converted into parental morphine units for analysis. Numeric pain rating scale (NPRS) scores at two, four, eight, 12, 16, 20, and 24 hours after leaving the PACU were collected. Two-tailed paired T-test was performed to compare the narcotic consumption and pain scores between the TAP block group and the non-TAP block group. Results WPH used ultrasound-guided bilateral TAP block for patients undergoing abdominal hysterectomies. 63 patient charts were evaluated with 32 in the TAP block group and 31 in the non-TAP block group. Narcotic consumption was significantly different in the PACU with TAP block group consuming less narcotics than non-TAP block group (5.05 vs 8.65 IV morphine equivalents, p=0.012). TAP block group's mean narcotic consumption was not significantly lower than Non-TAP block group's mean consumption during intra-operation, first 24 hours after admittance, and total hospital stay (p=0.419, p=0.533, p=0.754 respectively). Mean NPRS scores at all hours (2, 4, 8, 12, 16, 20, and 24) displayed no statistical difference between the two groups. Total patient-controlled analgesia (PCA) and total overall oral narcotic usage showed no statistically significant differences between TAP block group and Non-TAP block group (p=0.252, 0.669 respectively). Conclusion The results of this study demonstrated that TAP block did reduce narcotic requirement in the PACU but did not exhibit superior analgesic efficacy after discharge from the PACU, nor reduce the total length of hospital stay.
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Affiliation(s)
- Christina Dai
- Medicine, University of Central Florida College of Medicine , Orlando, USA
| | - Kai Zhang
- Medicine, University of Central Florida College of Medicine , Orlando, USA
| | - Jeffrey Huang
- Anesthesiology, University of Central Florida, Orlando, USA
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Aboelela MA, Kandeel AR, Elsayed U, Elmorshedi M, Elsarraf W, Elsayed E, Elgawalby A, Sultan AM, Wahab MA, Yassen A. Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study. Saudi J Anaesth 2018; 12:297-303. [PMID: 29628844 PMCID: PMC5875222 DOI: 10.4103/sja.sja_577_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation. METHODS A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers. RESULTS Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake (P = 0.04), morphine requirement (P = 0.03), and first time of analgesia intake (P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect. CONCLUSION Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.
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Affiliation(s)
- Mohamed Adel Aboelela
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Al-Refaey Kandeel
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Usama Elsayed
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Elmorshedi
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Waleed Elsarraf
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Eman Elsayed
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
| | - Ahmed Elgawalby
- Department of General Surgery, Faculty of Medicine, Mansoura University, Egypt
| | | | - Mohamed Abdel Wahab
- Department of General Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Amr Yassen
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
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Aksu R, Patmano G, Biçer C, Emek E, Çoruh AE. Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis plane block ultrasound guided in postoperative pain of abdominal surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28551060 PMCID: PMC9391676 DOI: 10.1016/j.bjane.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background and objectives We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Methods Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21 mL 0.9% saline in Group C (n = 31), 20 mL 0.5% bupivacaine + 1 mL saline in Group B (n = 31), and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 μg) in Group BD (n = 31). Results Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p < 0.05); it was lower in group BD than in group B at 10–24 h. In Group B, it was lower than Group C at 2–8 h (p < 0.05). Total morphine consumption was lower in Group BD compared to other groups and lower in group B than in the controls (p < 0.001). Patient satisfaction was higher in Group BD than in other groups and was higher in both study groups than in the controls (p < 0.001). Nausea-vomiting scores, antiemetic requirement, or additional analgesic administration were not significant among groups (p > 0.05). Conclusions The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.
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Affiliation(s)
- Recep Aksu
- Erciyes University, Medical Faculty, Department of Anesthesiology, Kayseri, Turquia.
| | - Gülçin Patmano
- Erciyes University, Medical Faculty, Department of Anesthesiology, Kayseri, Turquia
| | - Cihangir Biçer
- Erciyes University, Medical Faculty, Department of Anesthesiology, Kayseri, Turquia
| | - Ertan Emek
- Erciyes University, Medical Faculty, Department of General Surgery, Kayseri, Turquia
| | - Aliye Esmaoğlu Çoruh
- Erciyes University, Medical Faculty, Department of General Surgery, Kayseri, Turquia
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Tang C, Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. J Pain Res 2017; 10:1899-1904. [PMID: 28860845 PMCID: PMC5565238 DOI: 10.2147/jpr.s139387] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Many nociceptive, inflammatory, and neuropathic pathways contribute to perioperative pain. Although opioids have long been a mainstay for perioperative analgesia, other non-opioid therapies, and dexmedetomidine, in particular, have been increasingly used as part of a multimodal analgesic regimen to provide improved pain control while minimizing opioid-related side effects. This article reviews the evidence supporting the preoperative, intraoperative, and postoperative efficacy of dexmedetomidine as an adjuvant, and the efficacy of intravenous, spinal canal, and nerve block analgesia with dexmedetomidine for perioperative acute pain treatment. While there have not been any large-scale clinical trials conducted, the current body of evidence suggests that dexmedetomidine is suitable for use as an adjuvant analgesic at all perioperative stages. However, there are potential adverse effects, such as hypotension and bradycardia, which must be taken into consideration by clinicians.
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Affiliation(s)
- Chaoliang Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
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Thapa D, Dhiman D, Ahuja V, Gombar S, Gupta RK. Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries. Br J Pain 2017; 12:26-34. [PMID: 29416862 DOI: 10.1177/2049463717720788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far. Methods The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 μg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 μg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours. Results The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51). Conclusion Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.1.
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Affiliation(s)
- Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Deepanshu Dhiman
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Ravi K Gupta
- Department of Orthopaedics, Government Medical College & Hospital, Chandigarh, Chandigarh, India
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Ding W, Li W, Zeng X, Li J, Jiang J, Guo C, Li W. Effect of Adding Dexmedetomidine to Ropivacaine on Ultrasound-Guided Dual Transversus Abdominis Plane Block after Gastrectomy. J Gastrointest Surg 2017; 21:936-946. [PMID: 28374183 DOI: 10.1007/s11605-017-3402-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/08/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Transversus abdominis plane (TAP) block is an analgesic technique. Adding dexmedetomidine can enhance regional anesthesia. This study's aim was to evaluate whether dexmedetomidine prolonged analgesic time of TAP block after gastrectomy. METHODS Patients scheduled for gastrectomy were randomly assigned to receive a TAP block with saline (group S), ropivacaine (group R), or ropivacaine and dexmedetomidine (group RD). Visual analogue scale (VAS) scores, postoperative nausea and vomiting (PONV) scores, sedation scores, tramadol consumption, ropivacaine concentration, and Quality of Recovery Questionnaire 40 (QoR-40) were recorded. RESULTS Patients in group R and group RD had lower VAS scores 2, 4, 12, and 24 h after surgery compared with group S (P < 0.05). PONV scores were lower in group R and group RD compared with group S after 2, 12, 24, and 36 h (P < 0.05). Patients in group R and group RD required less tramadol and had better QoR-40 scores than those in group S (P < 0.05). The aforementioned variables and ropivacaine concentrations did not differ between group R and group RD (P > 0.05). Sedation scores were similar between three groups (P > 0.05). CONCLUSIONS TAP block can provide analgesia and improve the quality of recovery. Adding dexmedetomidine does not significantly improve the quality or duration of TAP block.
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Affiliation(s)
- Wengang Ding
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Wanying Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Xianzhang Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Jinying Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Jingjing Jiang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Changchun Guo
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China
| | - Wenzhi Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246, Xuefu Road, Harbin, Heilongjiang, 150086, China.
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Abstract
Alpha-2 adrenergic receptors are spread throughout the central and peripheral nervous system, specifically in the pontine locus coeruleus, medullospinal tracts, rostral ventrolateral medulla, and the dorsal horn of the spinal cord. Alpha-2 agonist agents cause neuromodulation in these centers, leading to sedation, analgesia, vasodilatation, and bradycardia with little effect on the respiratory drive, which accounts for their good safety profile. The 2 major drugs in this group are clonidine and dexmedetomidine. Their clinical applications in anesthesia practice include providing sedation in the intensive care unit or for minor procedures, adjuvant to general and regional anesthesia, analgesia, and as premedicating agents.
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Affiliation(s)
- Viet Nguyen
- Department of Anesthesiology, LSUHSC-NO, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA
| | - Dawn Tiemann
- Department of Anesthesiology, LSUHSC-NO, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA
| | - Edward Park
- Department of Anesthesiology and Perioperative Medicine, Ronald Regan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA
| | - Ali Salehi
- Department of Anesthesiology and Perioperative Medicine, Ronald Regan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
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