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Tang R, Lu WS, Zhong HL, Wu F, Liu YQ. Comparison of different adjuvant analgesia for paravertebral block in video-assisted thoracoscopic surgery: A double-blind randomized controlled trial. PLoS One 2025; 20:e0322589. [PMID: 40315237 PMCID: PMC12047843 DOI: 10.1371/journal.pone.0322589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 03/23/2025] [Indexed: 05/04/2025] Open
Abstract
BACKGROUND Local anaesthetic adjuvants have been shown to provide better pain relief and extend the duration of analgesia. But little information is available on which adjuvants are more effective in block extension for thoracic paravertebral block (TPVB) during video-assisted thoracoscopic surgery (VATS). This study aimed to compare the analgesic efficacies of different adjuvants with 0.375% ropivacaine in ultrasound-guided TPVB for VATS. METHODS A total of 120 patients who underwent VATS at the study hospital in 2022-2023 were recruited and randomly divided into four groups, including the control group (Group R), which received 20 ml ropivacaine 0.375% for TPVB, and the intervention groups: Group D (0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for TPVB), group E (0.375% ropivacaine with 0.1 mg/kg dexamethasone in a total of 20 ml for TPVB), and group S (0.375% ropivacaine with 0.5ug/ml sufentanil in a total of 20 ml for TPVB). They received a single-injection ultrasound-guided unilateral T5-level TPVB. The primary clinical outcomes were visual analogue scale (VAS) pain scores at rest and during coughing at 4, 8, 12, 16, 20, 24, and 48 h postoperatively. Secondary outcomes included opioid consumption, number of patient-controlled intravenous analgesics (PCIA) used within 48 h, postoperative rescue analgesia, side effects, quality of recovery after surgery, and length of hospital stay. RESULTS We found that the VAS pain scores in the resting state during the postoperative period at 12-20 h were lower in Group D than in Group R (P < 0.05). The resting VAS pain scores of Groups E and S were lower than those of Group R during the postoperative period of 12-16 h (P < 0.05). Similar differences were observed in the pain scores during coughing at the same time points. Additionally, the co-administration of adjuvants with ropivacaine were associated with decreased consumption of postoperative opioids, less frequent PCIA use, and earlier time to ambulation. The intergroup pairwise comparisons showed that dexmedetomidine was more effective than dexamethasone and sufentanil in reducing additional postoperative analgesics, the length of chest tube placement and length of hospital stay. Subsequently, we administered questionnaires on the quality of recovery, which was positively correlated with the postoperative analgesic effect. CONCLUSIONS These findings suggest that adjuvant analgesia for TPVB can improve postoperative pain in patients undergoing VATS. However, compared with dexamethasone and sufentanil, dexmedetomidine is more effective in extending the duration of analgesia, reducing the demand of postoperative analgesics, improving the quality of recovery at 48 h postoperatively and shorting the length of hospital stay.
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Affiliation(s)
- Rong Tang
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Wen-sheng Lu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Hai-lian Zhong
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Fang Wu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yu-qian Liu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, China
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Neishaboury M, Shokri S, Kianpour P, Farhadi K, Najjari K, Sharifnia H, MohammadYousef R, Khajavi M. The Effects of Intraperitoneal Dexmedetomidine in Comparison with Ropivacaine in Postoperative Pain After Laparoscopic Sleeve Gastrectomy: A Double-Blind, Randomized, Placebo-Controlled, Clinical Trial. Obes Surg 2025:10.1007/s11695-025-07871-z. [PMID: 40281250 DOI: 10.1007/s11695-025-07871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 04/04/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Studies have shown that non-opioid analgesic drugs can reduce the pain of patients after bariatric surgery. Ropivacaine and dexmedetomidine are associated with high efficacy and safety in managing postoperative complications. We evaluated the effectiveness of ropivacaine alone and in combination with dexmedetomidine in improving outcomes after sleeve gastrectomy surgery. METHODS This double-blind, randomized clinical trial, included patients undergoing bariatric surgery in 2022 and 2023. The participants were randomly divided into three groups: treated with ropivacaine alone (group A), ropivacaine and dexmedetomidine combination (group B), or normal saline (group C). Pain scores, morphine consumption, and postoperative nausea and vomiting (PONV) were assessed over 24 h. RESULTS All groups showed reduced pain, but group B had significantly lower VAS scores than groups A and C at 4-24 h postoperatively, with the highest difference achieved by group B compared to control at 12-h time point (β = - 2.5, P < 0.001). Morphine use was lowest in group B (4.38 ± 1.24 mg vs. 6.04 ± 2.07 mg in group A and 7.50 ± 2.55 mg in group C; P < 0.001). PONV incidence was also lower in group B (8.3% vs. 29.2% in group A and 50% in group C; P = 0.008). CONCLUSIONS The ropivacaine and dexmedetomidine combination therapy was associated with a greater pain relief effect after sleeve gastrectomy, a greater reduction in the need to take opioids, and a lower frequency of PONV compared to the ropivacaine alone or placebo.
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Affiliation(s)
- Mohamadreza Neishaboury
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Samira Shokri
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Parisa Kianpour
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of.
| | - Kousha Farhadi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Khosrow Najjari
- Department of General Surgery, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Hamidreza Sharifnia
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Rana MohammadYousef
- Department of Anesthesiology and Critical Care, School of Medicine, Childrens Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Mohammadreza Khajavi
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of.
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Migliorini F, Pappalardo G, Bardazzi T, Maffulli N, Bertini FA, Simeone F, Vaishya R, Memminger MK. Continuous femoral nerve block as pain management following total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 2025; 145:238. [PMID: 40214694 DOI: 10.1007/s00402-025-05855-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Accepted: 03/28/2025] [Indexed: 04/17/2025]
Abstract
INTRODUCTION The present systematic review evaluated the current level of I evidence on continuous femoral nerve block (FNB) as pain management following total knee arthroplasty (TKA), comparing different drugs. MATERIALS AND METHODS This study followed the 2020 PRISMA guidelines. PubMed, Embase and Web of Science were accessed in November 2024. All clinical studies concerning continuous FNB for pain management following TKA were considered. RESULTS Data from 22 RCTs were retrieved. The drugs included in the analyses were levobupivacaine, bupivacaine and ropivacaine in isolation or combined with prilocaine or dexmedetomidine. A statistically significant difference was found in VAS at rest in postoperative day (POD) 0 (p < 0.01): the bupivacaine group demonstrated the highest values, and the ropivacaine combined with dexmedetomidine group had the lowest values. No other statistically significant difference in VAS at rest was found for any group in POD 1, 2, and 3 (p = 0.1, p = 0.1, and p = 0.4, respectively). The groups receiving ropivacaine combined with dexmedetomidine and prilocaine had the lowest values of VAS during activity in POD2 (p < 0.01), while in POD3 the groups receiving ropivacaine combined with prilocaine and the bupivacaine one had the lowest values (p < 0.01). No significant difference was found in VAS during activity between any group in POD 0 (p = 0.4) and POD 1 (p = 0.3). CONCLUSION Ropivacaine combined with dexmedetomidine might be the best compound for continuous femoral nerve block to manage pain following TKA during the first PODs. Further high-quality investigations are necessary to validate these findings in clinical settings.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES- ASDAA), Bolzano, 39100, Italy.
- Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Halle (Saale), 06097, Germany.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, Rome, 00165, Italy.
| | | | - Tommaso Bardazzi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES- ASDAA), Bolzano, 39100, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Keele, UK
- Department of Medicine and Psicology, University La Sapienza, Rome, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesca Alzira Bertini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES- ASDAA), Bolzano, 39100, Italy
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES- ASDAA), Bolzano, 39100, Italy
| | - Raju Vaishya
- Department of Orthopaedic and Trauma Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael Kurt Memminger
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES- ASDAA), Bolzano, 39100, Italy
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Maagaard M, Andersen JH, Jaeger P, Mathiesen O. Effects of combined dexamethasone and dexmedetomidine as adjuncts to peripheral nerve blocks: a systematic review with meta-analysis and trial sequential analysis. Reg Anesth Pain Med 2025; 50:311-320. [PMID: 38253609 DOI: 10.1136/rapm-2023-105098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND/IMPORTANCE The effects of combining dexamethasone and dexmedetomidine on block duration are unclear. OBJECTIVE To investigate the effects of combining dexamethasone and dexmedetomidine on block duration. EVIDENCE REVIEW Systematic review of randomized controlled trials (RCTs) from Medline, Embase, CENTRAL, CINAHL, the Web of Science, and BIOSIS until June 8, 2023. RCTs with adults undergoing surgery with a peripheral nerve block randomized to combined dexamethasone and dexmedetomidine versus placebo or other adjuncts were eligible. Primary outcome was duration of analgesia. We performed meta-analysis, trial sequential analysis, risk of bias-2, and Grading Recommendations Assessment, Development, and Evaluation assessment. FINDINGS We included 9 RCTs with 14 eligible comparisons. The combination of dexamethasone and dexmedetomidine was compared with placebo in three RCTs (173 participants), dexamethasone in seven (569 participants), and dexmedetomidine in four (281 participants). The duration of analgesia was likely increased with the combination versus placebo (mean difference 460 min, 95% CI 249 to 671) and versus dexmedetomidine (mean difference 388 min, 95% CI 211 to 565). The duration was likely similar with the combination versus dexamethasone (mean difference 50 min, 95% CI -140 to 239). The certainty of the evidence was moderate because most trials were at high risk of bias. CONCLUSIONS Combined dexamethasone and dexmedetomidine likely increased the duration of analgesia when compared with placebo and dexmedetomidine. The combination likely provided a similar duration of analgesia as dexamethasone. Based on this systematic review, it seems reasonable to use dexamethasone as the sole adjunct if the goal is to increase the duration of analgesia.
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Affiliation(s)
| | | | - Pia Jaeger
- Department of Anaesthesia, the Juliane Marie Centre, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ole Mathiesen
- Anaesthesiology, Zealand University Hospital, Koge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Theodoraki K, Koutalas I, Orfanou C. Evaluation of the Adjuvant Effect of Dexmedetomidine on Ropivacaine for Transversus Abdominis Plane Block in Inguinal Hernia Repair: A Prospective Double-Blind Randomized Trial. J Clin Med 2025; 14:2478. [PMID: 40217927 PMCID: PMC11990006 DOI: 10.3390/jcm14072478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/31/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025] Open
Abstract
Background and goal of study: The aim of this double-blind randomized study was to investigate the efficacy of dexmedetomidine as an adjuvant to the local anesthetic in transversus abdominis plane (TAP) block for unilateral inguinal hernioplasty. Materials and Methods: Eighty eligible patients were randomly allocated into ultrasound-guided TAP block with either dexmedetomidine 0.5 mcg/kg diluted to a volume of 2 mL and ropivacaine 0.5% 25 mL (DR group) or ropivacaine 0.5% 25 mL and normal saline 2 mL (R group). The primary endpoint of this study was the numeric rating scale (NRS) score during coughing 24 h postoperatively. Secondary parameters were also evaluated. Results: Patients in the RD group demonstrated significantly less pain at rest three, six and 12 h postoperatively as compared to patients in the R group (p = 0.002, 0.032 and 0.049, respectively). Significant differences between the two groups were also demonstrated for NRS scores during coughing at 3, 6 and 12 h postoperatively (p = 0.013, 0.035 and 0.042, respectively). Additionally, the RD group demonstrated lower intraoperative remifentanil consumption (p < 0.001), lower PACU morphine requirement (p = 0.012) and lower overall PCA morphine requirement postoperatively (p < 0.001). Sedation scores, the incidence of hypotension, bradycardia and the occurrence of postoperative nausea and vomiting were no different between the two groups. Finally, the incidence of chronic pain at 6 months was significantly lower in the RD group compared to the R group (5.55% vs. 25%, p = 0.049). Conclusions: Dexmedetomidine as an adjuvant to ropivacaine reduces postoperative pain scores, has opioid-sparing effects and is associated with a favorable effect on chronic pain without side effects in patients subjected to TAP block for inguinal hernia repair.
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Chen Z, Zhang L, Lu G, Zhang Y, Zhao D, Zhao S, Zhang H, Jin Y, Zhao X, Jin Y. Effects of Dexmedetomidine as an Adjuvant in Preoperative Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block on Postoperative Sore Throat and Hemodynamics in Patients With Double-Lumen Endotracheal Intubation: A Randomized Controlled Trial. J Pain Res 2025; 18:229-241. [PMID: 39846004 PMCID: PMC11750727 DOI: 10.2147/jpr.s498538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Accepted: 01/07/2025] [Indexed: 01/24/2025] Open
Abstract
Background Postoperative sore throat (POST) is a significant adverse effect after endotracheal intubation, especially with double-lumen endotracheal tubes (DLTs). Ultrasound-guided internal branch of the superior laryngeal nerve block (US-guided iSLNB) presents a potential intervention for POST. In this first randomized controlled trial to date, we aimed to investigate the effects of US-guided iSLNB, with or without perineural dexmedetomidine, on the incidence and severity of POST following DLTs. Methods A total of 159 patients were randomly assigned to three groups: control, bilateral US-guided iSLNB (2 mL 0.20% ropivacaine + 1 mL saline on each side), and bilateral US-guided iSLNB combined with perineural dexmedetomidine group (2 mL 0.20% ropivacaine + 1 mL 0.5 μg·kg-1 dexmedetomidine on each side). The incidence and severity of POST, hemodynamic fluctuations during intubation and extubation, the incidence and severity of cough and agitation during extubation, and perioperative complications were assessed. The primary outcome was the incidence of POST at 6 h after surgery. Results Compared with the control group, preoperative US-guided iSLNB significantly reduced the incidence and severity of POST at 1 and 6 h after surgery, mitigated the incidence and severity of cough during extubation, and attenuated hemodynamic responses, including heart rate, mean arterial pressure, and rate-pressure product during intubation, 1 min after intubation, and 1 min after extubation (all P < 0.01). Compared with US-guided iSLNB alone, the combination of US-guided iSLNB with perineural dexmedetomidine reduced the incidence and severity of POST at 1, 6, and 12 h, as well as coughing during extubation (all P < 0.01). However, it demonstrated little effect on hemodynamics (all P > 0.05). No significant perioperative complications were observed in the three groups (all P > 0.05). Conclusion Preoperative US-guided iSLNB combined with perineural dexmedetomidine effectively reduced the incidence, severity, and duration of POST and cough during extubation. No additional hemodynamic benefits were observed. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR2200061001).
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Affiliation(s)
- Zheping Chen
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200434, People’s Republic of China
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Le Zhang
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Guodong Lu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Yizheng Zhang
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Dexu Zhao
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Shanshan Zhao
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - He Zhang
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Yuelong Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, 241001, People’s Republic of China
| | - Xin Zhao
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
| | - Yanwu Jin
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- The second Clinical College of Shandong University, Jinan, 250033, People’s Republic of China
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Wang K, Wang Y, Zhang T, Chang B, Fu D, Chen X. The Role of Intravenous Anesthetics for Neuro: Protection or Toxicity? Neurosci Bull 2025; 41:107-130. [PMID: 39153174 PMCID: PMC11748649 DOI: 10.1007/s12264-024-01265-4] [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: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 08/19/2024] Open
Abstract
The primary intravenous anesthetics employed in clinical practice encompass dexmedetomidine (Dex), propofol, ketamine, etomidate, midazolam, and remimazolam. Apart from their established sedative, analgesic, and anxiolytic properties, an increasing body of research has uncovered neuroprotective effects of intravenous anesthetics in various animal and cellular models, as well as in clinical studies. However, there also exists conflicting evidence pointing to the potential neurotoxic effects of these intravenous anesthetics. The role of intravenous anesthetics for neuro on both sides of protection or toxicity has been rarely summarized. Considering the mentioned above, this work aims to offer a comprehensive understanding of the underlying mechanisms involved both in the central nerve system (CNS) and the peripheral nerve system (PNS) and provide valuable insights into the potential safety and risk associated with the clinical use of intravenous anesthetics.
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Affiliation(s)
- Kaixin Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Bingcheng Chang
- The Second Affiliated Hospital of Guizhou, University of Traditional Chinese Medicine, Guiyang, 550003, China
| | - Daan Fu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Key Laboratory of Anesthesiology and Resuscitation, (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China.
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Key Laboratory of Anesthesiology and Resuscitation, (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China.
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Boyev A, Popat K, Gottumukkala VNR, Kwater AP, Chiang YJ, Prakash LR, Newhook TE, Arvide EM, Dewhurst WL, Bruno ML, Van Meter A, Hancher-Hodges S, Ghebremichael S, Williams U, Donahue H, Soliz J, Tzeng CWD. Postoperative pain scores and opioid use after standard bupivacaine vs. liposomal bupivacaine regional blocks for abdominal cancer surgery: A propensity score matched study. Am J Surg 2024; 237:115770. [PMID: 38789322 DOI: 10.1016/j.amjsurg.2024.05.011] [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: 02/04/2024] [Revised: 05/11/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Fascial plane blocks (FPBs) are widely used for abdominal surgery with the assumption that liposomal bupivacaine (LB) is more effective than standard bupivacaine (SB). METHODS This was a single-institution retrospective cohort study of patients administered FPBs with LB or SB + admixtures (dexamethasone/dexmedetomidine) for open abdominal cancer surgery. Propensity score matching generated a 2:1 (LB:SB) matched cohort. Opioid use (mg oral morphine equivalents, OME) and severe pain (≥3 pain scores ≥7 in a 24-h period) were compared. RESULTS Opioid use was >150 mg OME in 19.9 % (29/146) LB and 16.4 % (12/73) SB patients (p = 0.586). Severe pain was experienced by 44 % (64/146) LB and 53 % (39/73) SB patients (p = 0.198). On multivariable analysis, SB vs LB choice was not associated with high opioid volume >150 mg or severe pain. CONCLUSIONS FPBs with standard bupivacaine were not associated with higher 72-h opioid use or more severe pain compared to liposomal bupivacaine.
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Affiliation(s)
- Artem Boyev
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyuri Popat
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vijaya N R Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrzej P Kwater
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi-Ju Chiang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elsa M Arvide
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Whitney L Dewhurst
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morgan L Bruno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Antoinette Van Meter
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon Hancher-Hodges
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Semhar Ghebremichael
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uduak Williams
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hart Donahue
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose Soliz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Chen C, Xiang G, Chen K, Liu Q, Wang Y, Wang B, Qian J, Chen Y, Yang D, Deng X. Relative effects of serratus anterior plane block performed with dexmedetomidine combined with ropivacaine or ropivacaine alone on quality of recovery in children undergoing ear reconstruction. J Plast Reconstr Aesthet Surg 2024; 98:1-9. [PMID: 39213903 DOI: 10.1016/j.bjps.2024.08.060] [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: 04/21/2024] [Revised: 08/05/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Dexmedetomidine (Dex) as a local anesthesia adjuvant for nerve block procedures can improve the quality of patient recovery. However, the impact of using Dex as a local anesthetic adjuvant for serratus anterior plane block (SAPB) procedures on recovery quality for children undergoing ear reconstruction remains unclear. METHODS Eighty-four patients who underwent ear reconstruction with autogenous costal cartilage (ACC) were randomized into two groups (n = 42/group) in which SAPB was performed with ropivacaine alone (R group) and with Dex and ropivacaine (DR group). Primary outcomes were patient 15-item quality of recovery (QoR-15) scale scores on days 1 and 2 post-surgery. Secondary outcomes included postoperative rest and coughing numerical rating scale (NRS) chest pain scores, duration of analgesia, oral rescue analgesic usage, and opioid-related side effects. RESULTS Forty patients per group completed the study. QoR-15 scores on days 1 and 2 post-surgery in the DR group were significantly increased relative to the R group (126.35 ± 9.81 vs. 115.53 ± 8.58 and 131.78 ± 8.67 vs. 122.80 ± 8.59, all P < 0.001). Rest and coughing NRS chest pain scores at 2, 4, 8, 12, and 24 h postoperatively in the DR group were all significantly lower relative to the R group (all P < 0.05). The DR group also exhibited significantly longer analgesic duration (P < 0.001) and significantly reduced incidences of oral rescue analgesic usage and opioid-related side effect (all P < 0.05). CONCLUSION Combining Dex and ropivacaine for SAPB in children undergoing ear reconstruction with ACC can significantly improve the quality of recovery, quality of analgesia, and analgesic duration.
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Affiliation(s)
- Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Yue Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Bingqing Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Jin Qian
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Yuan Chen
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China.
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan, Beijing 100144, China.
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10
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Nakamura H, Makiguchi T, Yamada Y, Sakurai K, Tsunoda A, Tomaru N, Shirabe K, Yokoo S. Surgery With Peripheral Nerve Block Under Dexmedetomidine Sedation for Foot Ulcer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6333. [PMID: 39583786 PMCID: PMC11584224 DOI: 10.1097/gox.0000000000006333] [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: 03/17/2024] [Accepted: 10/02/2024] [Indexed: 11/26/2024]
Abstract
Background Patients who require surgical treatment for diabetic foot ulcer (DFU) or chronic limb-threatening ischemia (CLTI) are often in generally poor condition and have complications. General anesthesia may be risky in surgery for such patients. Thus, the authors perform surgery using peripheral nerve block under dexmedetomidine sedation for patients with DFU and CLTI. Methods This study evaluated intraoperative stress, anxiety, and safety in 18 patients undergoing peripheral nerve block with dexmedetomidine. Sedation levels were assessed using the observer's assessment of alertness/sedation (OAA/S) score on a 5-point scale from 5 (awake) to 1 (deeply sedated). Postoperatively, a questionnaire was administered to assess intraoperative stress and memory. Intraoperative stress was assessed using a 6-point face scale (0 to 6: not at all to unbearably high), and intraoperative memory was rated on a 5-point numeric scale (1 to 5: no memory to everything). Results The intraoperative OAA/S score was 3-5, indicating that appropriate sedation was obtained. The mean intraoperative stress score was 0.72 (range: 0-3), and the mean intraoperative memory score was 2.44 (range: 1-4). One patient had bradycardia and 9 had hypoxemia. All of these cases were improved by decreasing the dose of dexmedetomidine and encouraging deep breathing on call. Conclusions These results suggest that this procedure is a useful method to reduce patient burden and alleviate stress and anxiety during surgery. However, dexmedetomidine may cause hypoxemia in patients with DFU or CLTI; thus, attention should be paid to hypoxemia and countermeasures should be taken against this adverse effect.
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Affiliation(s)
- Hideharu Nakamura
- From the Department of Plastic and Reconstructive Surgery, National Hospital Organization, Takasaki-shi, Japan
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Takaya Makiguchi
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Yumi Yamada
- From the Department of Plastic and Reconstructive Surgery, National Hospital Organization, Takasaki-shi, Japan
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Kei Sakurai
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Aya Tsunoda
- From the Department of Plastic and Reconstructive Surgery, National Hospital Organization, Takasaki-shi, Japan
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Nana Tomaru
- From the Department of Plastic and Reconstructive Surgery, National Hospital Organization, Takasaki-shi, Japan
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi-shi, Japan
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11
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Jamshidi M, Ghaderi M, Hojatansari M. Comparing Analgesic Efficacy: Ropivacaine with Dexamethasone vs. Ropivacaine with Dexmedetomidine After Cesarean Section Using Transversus Abdominis Plane Block (2020 - 2021). Anesth Pain Med 2024; 14:e147872. [PMID: 40078658 PMCID: PMC11895784 DOI: 10.5812/aapm-147872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/14/2024] [Accepted: 09/21/2024] [Indexed: 03/14/2025] Open
Abstract
Background There are several methods for managing postpartum pain. The combined use of drugs with anesthetics can lead to effective pain management. Objectives The present study aimed to compare the analgesic effects of ropivacaine (RPV) + dexamethasone (DEXA) and RPV + dexmedetomidine (DEX) on pain after cesarean section (CS) using the transversus abdominis plane (TAP) block. Methods This double-blind, randomized clinical trial employed a quadruple block randomization method and included 40 participants scheduled for CS at Ayatollah Mousavi Hospital in Zanjan, Iran, during 2020 - 2021. The participants were divided into two groups: The first group received 15 mL of RPV 2% combined with 100 µg of DEX via the bilateral TAP block method, while the second group received 15 ml of RPV 2% combined with 8 mg of DEXA. The analgesic effects of the two drug combinations were evaluated at 0, 3-, 6-, 12-, and 24-hours post-CS using the visual analog scale (VAS) to measure pain intensity. Data analysis was conducted using SPSS software, version 24. Results In the RPV + DEX group, the onset of pain was delayed, resulting in a longer duration before the administration of painkillers (P = 0.041 and P < 0.001). However, pain intensity between 3- and 24-hours post-surgery was significantly higher in the RPV + DEX group compared to the RPV + DEXA group (P = 0.028, P < 0.001). The RPV + DEX group experienced longer durations before the onset of pain and the need for painkillers (P = 0.041, P < 0.001). Hypotension was more frequently observed in the RPV + DEXA group at 0 hours (P = 0.068) and 3 hours post-surgery (P = 0.003). Additionally, bradycardia and sedation incidences were higher in the RPV + DEXA group at 3 hours post-surgery (P = 0.005, P = 0.048). Conclusions The use of RPV + DEXA, unlike RPV + DEX, demonstrated positive and significant effects on pain management in female CS candidates using the TAP block method, despite its side effects.
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Affiliation(s)
| | - Mona Ghaderi
- School of Medicine, Zanjan Medical University, Zanjan, Iran
| | - Mitra Hojatansari
- Department of Emergency and Critical Care Nursing, School of Nursing and Midwifery, Zanjan University Sciences, Zanjan, Iran
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12
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Suleiman NN, Luedi MM, Joshi G, Dewinter G, Wu CL, Sauter AR. Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Reg Anesth Pain Med 2024; 49:635-641. [PMID: 38124208 PMCID: PMC11420763 DOI: 10.1136/rapm-2023-105024] [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: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND/IMPORTANCE Cleft palate surgery is associated with significant postoperative pain. Effective pain control can decrease stress and agitation in children undergoing cleft palate surgery and improve surgical outcomes. However, limited evidence often results in inadequate pain control after cleft palate surgery. OBJECTIVES The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after cleft palate surgery using procedure-specific postoperative pain management (PROSPECT) methodology. EVIDENCE REVIEW MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials and systematic reviews assessing pain in children undergoing cleft palate repair published in English language from July 2002, through August 2023. FINDINGS Of 1048 identified studies, 19 randomized controlled trials and 4 systematic reviews met the inclusion criteria. Interventions that improved postoperative pain, and are recommended, include suprazygomatic maxillary nerve block or palatal nerve block (if maxillary nerve block cannot be performed). Addition of dexmedetomidine to local anesthetic for suprazygomatic maxillary nerve block or, alternatively, as intravenous administration perioperatively is recommended. These interventions should be combined with a basic analgesic regimen including acetaminophen and nonsteroidal anti-inflammatory drugs. Of note, pre-incisional local anesthetic infiltration and dexamethasone were administered as a routine in several studies, however, because of limited procedure-specific evidence their contribution to pain relief after cleft palate surgery remains unknown. CONCLUSION The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients. PROSPERO REGISTRATION NUMBER CRD42022364788.
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Affiliation(s)
- Nergis Nina Suleiman
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Girish Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geertrui Dewinter
- Department of Cardiovascular Sciences, Section Anesthesiology, KU Leuven and University Hospital Leuven, Leuven, Belgium
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Axel R Sauter
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
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13
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Zadrazil M, Marhofer P, Opfermann P, Schmid W, Marhofer D, Zeilberger M, Pracher L, Zeitlinger M. Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers. Anesthesiology 2024; 141:24-31. [PMID: 38558118 DOI: 10.1097/aln.0000000000004988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that they would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, the authors designed a randomized, controlled, triple-blinded, single-center study in volunteers. METHODS Volunteers aged 18 to 55 yr (body mass index, 18 to 35 kg/m2) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of 36 days or more, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar's tests, as well as a generalized estimation equation model. RESULTS Successful sensory blockade was noted in 8 of 25 volunteers (32%) after liposomal and in 25 of 25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in four of five hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in one of five areas (P < 0.001; P < 0.001). Carryover effects due to the randomized sequencing were unlikely (estimate, -0.6286; sequence effect, 0.8772; P = 0.474). Self-assessment greater than 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade. CONCLUSIONS The results show that liposomal bupivacaine is not a suitable "sole" drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Markus Zadrazil
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Opfermann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Werner Schmid
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniela Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mira Zeilberger
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Lena Pracher
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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14
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Waloejo CS, Musalim DAP, Budi DS, Pratama NR, Sulistiawan SS, Wungu CDK. Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3166. [PMID: 38892876 PMCID: PMC11172819 DOI: 10.3390/jcm13113166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = -1.99 [95% CI -3.01 to -0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = -1.34 [95% CI -2.29 to -0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile.
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Affiliation(s)
- Christrijogo Soemartono Waloejo
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (C.S.W.)
| | | | - David Setyo Budi
- Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Nando Reza Pratama
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Soni Sunarso Sulistiawan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (C.S.W.)
| | - Citrawati Dyah Kencono Wungu
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
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15
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Xu Y, Kong X. Safety and efficacy of dexmedetomidine in combination with local anesthetics for orthopedic nerve blocks: a systematic review and meta-analysis. Minerva Anestesiol 2024; 90:427-438. [PMID: 38771166 DOI: 10.23736/s0375-9393.24.17879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Peripheral nerve block, a common technique for managing postoperative pain and providing intraoperative analgesia, often includes adjuncts like dexmedetomidine (DEX) to enhance the effectiveness of local anesthetics. DEX, known for its α2-adrenoceptor agonist properties, extends sensory blockade and improves postoperative analgesia while offering sedative benefits. The objective of this study is to rigorously assess the effectiveness and safety of perineural DEX injection in orthopedic nerve block procedures, focusing on orthopedic surgeries to minimize heterogeneity and provide clearer insights for clinical practice. EVIDENCE ACQUISITION This meta-analysis, registered on PROSPERO, involved a comprehensive literature search across multiple databases, focusing on RCTs comparing DEX with local anesthetics for peripheral nerve blocks in orthopedic surgery patients. The eligibility criteria included adult participants and various nerve block methods in orthopedic surgeries. Studies were rigorously appraised for methodological quality using Cochrane Handbook guidelines. GRADE profiler 3.6 was used for evidence grading. EVIDENCE SYNTHESIS Among 1391 documents, 21 studies were included, focusing on DEX with local anesthetics in orthopedic nerve blocks. Findings showed significant improvements in analgesia duration, sensory and motor block duration, and reduced postoperative opioid consumption, with an increased risk of bradycardia. Quality assessments indicated moderate bias risk. CONCLUSIONS DEX with local anesthetics significantly enhances nerve block effectiveness, extending analgesia and block durations while reducing opioid need. However, it requires careful monitoring due to increased bradycardia risk. These findings highlight the need for cautious use in clinical practice, considering both potential benefits and adverse effects.
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Affiliation(s)
- Yaqing Xu
- Department of Anesthesiology, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Xionghui Kong
- Department of Anesthesiology, Ningbo Sixth Hospital, Ningbo, Zhejiang, China -
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16
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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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17
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Li B, Yang X, Liu F, Huang H, Zhang B, Li X, Lu Q, Liu P, Fan L. Effect of Perineural or Intravenous Betamethasone on Femoral Nerve Block Outcomes in Knee Arthroplasty: A Randomized, Controlled Study. Orthop Surg 2024; 16:873-881. [PMID: 38384178 PMCID: PMC10984829 DOI: 10.1111/os.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Despite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic has been shown to improve postoperative pain. However, it remains uncertain whether the positive effects of perineural or intravenous administration of betamethasone on analgesia outcomes lead to better early mobility and postoperative recovery. METHODS Between June 2022 and February 2023, a total of 159 patients who were undergoing knee arthroplasty were included in this study. These patients were allocated randomly into three groups: (i) the NS group, received ropivacaine 0.375% and intravenous 3mL 0.9% normal saline; (ii) the PNB group, received ropivacaine 0.375% plus perineural betamethasone (12mg) 3mL and intravenous 3mL 0.9% normal saline; and (iii) the IVB group, received ropivacaine 0.375% and intravenous betamethasone (12mg) 3mL. RESULTS Both perineural and intravenous administration of betamethasone led to improved median (IQR) numeric rating scale (NRS) scores on the 6-meter walk test, with a score of 1.0 (1.0-2.0) for both groups, compared with 2.0 (1.0-2.0) for the NS group (p = 0.003). Compared to the NS group, both the PNB and IVB groups showed significant reductions in NRS scores at 24 and 36 h after surgery, along with a significant increase in ROM at 24, 36, and 48 h post-operation. Additionally, it exhibited lower levels of cytokine IL-1β and TNF-α in fluid samples, as well as lower level of HS-CRP in blood samples in the PNB and IVB groups compared to the NS group. CONCLUSION The administration of perineural and intravenous betamethasone demonstrated an enhanced analgesic effect following knee arthroplasty. Furthermore, it was associated with reduced levels of IL-1β, TNF-α, and HS-CRP, as well as enhanced knee ROM, which is conducive to early ambulation and postoperative rehabilitation after knee arthroplasty.
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Affiliation(s)
- Binglong Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
- Shandong University Cheeloo College of MedicineJinanChina
| | - Xiaomei Yang
- Shandong University Cheeloo College of MedicineJinanChina
- Department of Anaesthesiology, Qilu HospitalShandong UniversityJinanChina
- Department of Cardiology, the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineQilu Hospital of Shandong UniversityJinanChina
| | - Fang Liu
- Shandong University Cheeloo College of MedicineJinanChina
- Department of Anaesthesiology, Qilu HospitalShandong UniversityJinanChina
| | - Huang Huang
- Institute for In Vitro SciencesGaithersburgMDUSA
| | - Baoqing Zhang
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Xuezhou Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Qunshan Lu
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Peilai Liu
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Lixia Fan
- Department of Anaesthesiology, Qilu HospitalShandong UniversityJinanChina
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18
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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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19
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Zadrazil M, Marhofer P, Columb M, Opfermann P, Schmid W, Marhofer D, Stimpfl T, Reichel S, Al Jalali V, Zeitlinger M. The impact of biological sex in peripheral nerve blockade: A prospective pharmacodynamic, pharmacokinetic and morphometric study in volunteers. PLoS One 2024; 19:e0297095. [PMID: 38277353 PMCID: PMC10817111 DOI: 10.1371/journal.pone.0297095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024] Open
Abstract
STUDY OBJECTIVE The impact of biological sex in peripheral regional anaesthesia is largely unknown. We therefore designed a prospective study in volunteers to investigate the impact of biological sex on pharmacodynamic, pharmacokinetic and morphometric characteristics for peripheral nerve blockade. METHODS The initial study plan was powered to include 90 volunteers to find a difference of 35 min in duration of sensory block (primary outcome variable) with 80% power and alpha error at 5%. After discussions in ethical review, a pilot study of 2 x 12 volunteers from each sex were studied. Female and male volunteers received ultrasound guided nerve blockade with 3.0 mL ropivacaine 7.5 mg mL-1. Sensory duration of blockade, as the primary outcome, was evaluated by pinprick testing. Secondary outcomes were sensory onset time of blockade, pharmacokinetic characteristics and the visibility of ulnar nerves using ultrasound. Analyses included Mann-Whitney U-statistics with P<0.05 (two-sided) as significant. RESULTS After 24 participants, the median (IQR) duration of sensory blockade was 450 (420; 503) min in women and 480 (450; 510) min in men (P = 0.49). Sensory onset time of blockade, and ultrasound visibility of nerves were also similar between the study groups. The total drug exposure across time (AUC0-infinity) was significantly higher in women (P = 0.017). After a the planned power re-analysis after these 24 study paticipants, which suggested that > 400 subjects would be required with 80% power and alpha error of 5% to find significance for the primary outcome parameter for marginal differences, we terminated the study at this point. CONCLUSIONS We did not detect significant differences between female and male study participants in terms of pharmacodynamic and morphometric characteristics after ultrasound guided ulnar nerve blocks. Women did show significantly greater pharmacokinetic ropivacaine exposures. The results of this study indicate that peripheral regional block pharmacodynamic characteristics are independent of the biological sex, whereas pharmacokinetic parameters are sex-dependent.
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Affiliation(s)
- Markus Zadrazil
- Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Marhofer
- Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Malachy Columb
- Manchester University Hospitals NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Philipp Opfermann
- Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Werner Schmid
- Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniela Marhofer
- Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Clinical Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Reichel
- Clinical Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
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20
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Modir H, Moshiri E, Naghavi F. Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial. Natl J Maxillofac Surg 2024; 15:40-46. [PMID: 38690235 PMCID: PMC11057600 DOI: 10.4103/njms.njms_507_21] [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: 12/08/2021] [Revised: 07/26/2022] [Accepted: 08/09/2023] [Indexed: 05/02/2024] Open
Abstract
Objective This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients. Materials and Methods This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05. Results The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001). Conclusion The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy.
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Affiliation(s)
- Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Faezeh Naghavi
- Students Research Committee, Departments of Anesthesiology and Critical Care, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
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21
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Thawkar VN, Taksande K. Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block. Cureus 2023; 15:e48827. [PMID: 38106768 PMCID: PMC10722345 DOI: 10.7759/cureus.48827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Surgical procedures on the shoulder pose distinctive challenges in managing pain during the perioperative period, underscoring the importance of exploring innovative anesthesia techniques. This comprehensive review article delves into integrating dexmedetomidine, an alpha-2 adrenergic agonist, within interscalene brachial plexus blocks for shoulder surgery. The review initiates by underscoring the pivotal role of effective anesthesia in shoulder surgery and elucidates the rationale behind investigating dexmedetomidine as an adjunct. It meticulously examines the anatomy and physiology of the brachial plexus, emphasizing its critical significance in shoulder surgery. Furthermore, the article expounds on dexmedetomidine's mechanisms of action and pharmacokinetics, encompassing its safety profile and potential side effects. The conventional interscalene brachial plexus block techniques, along with their limitations and challenges, are discussed, laying the foundation for the integration of dexmedetomidine. The review subsequently delves into exploring the role of dexmedetomidine in regional anesthesia, covering previous studies, mechanisms of action, and the potential advantages of incorporating it into nerve blocks. The review's core concentrates on the practical application of dexmedetomidine-enhanced interscalene brachial plexus blocks. This includes discussions on administration techniques, dosage guidelines, and compelling evidence supporting its utilization. Clinical scenarios where this approach proves most advantageous are thoroughly explored, comparing its effectiveness with traditional techniques in terms of pain control and patient outcomes. A comprehensive examination of relevant clinical trials and case studies highlights the evidence supporting its efficacy. The review also underscores safety considerations associated with dexmedetomidine. It proposes strategies for mitigating risks to ensure patient safety. Insights into future directions and research are provided, encompassing ongoing studies, areas necessitating further investigation, and potential refinements in technique. Finally, the article summarizes key findings, emphasizing the practicality of dexmedetomidine-enhanced interscalene brachial plexus blocks in shoulder surgery and its far-reaching implications for clinical practice and patient care.
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Affiliation(s)
- Varun N Thawkar
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Karuna Taksande
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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22
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Finneran JJ, Ilfeld BM. Continuous peripheral nerve blocks for analgesia following painful ambulatory surgery: a review with focus on recent developments in infusion technology. Curr Opin Anaesthesiol 2023; 36:525-532. [PMID: 37552018 DOI: 10.1097/aco.0000000000001284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW Continuous peripheral nerve blocks (cPNB) decrease pain scores and opioid consumption while improving patient satisfaction following ambulatory surgery. This review focuses on the history and evolution of ambulatory cPNBs, recent developments in infusion technology that may prolong the duration of analgesia, optimal choice of cPNB for various surgical procedures, and novel analgesic modalities that may prove to be alternatives or supplements to cPNBs. RECENT FINDINGS The primary factor limiting the duration of an ambulatory cPNB is the size of the local anesthetic reservoir. Recent evidence suggests the use of automated boluses, as opposed to continuous infusions, may decrease the rate of consumption of local anesthetic and, thereby, prolong the duration of analgesia. Utilizing a long-acting local anesthetic (e.g. ropivacaine) for initial block placement and an infusion start-delay timer may further increase this duration. SUMMARY Patients undergoing painful ambulatory surgery are likely to have less pain and require fewer opioid analgesics when receiving a cPNB for postoperative analgesia. Advances in electronic pumps used for cPNBs may increase the duration of these benefits.
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Affiliation(s)
- John J Finneran
- Department of Anesthesiology, University of California San Diego, San Diego, California
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, California
- Outcomes Research Consortium, Cleveland, Ohio, USA
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23
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Desai N, Albrecht E. Local anaesthetic adjuncts for peripheral nerve blockade. Curr Opin Anaesthesiol 2023; 36:533-540. [PMID: 37314172 DOI: 10.1097/aco.0000000000001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW Moderate-to-severe pain is common and remains a significant problem. Compared with opioid analgesia alone, single-shot peripheral nerve blockade has been associated with improved pain relief and the potential of decreased side effects. Single-shot nerve blockade, however, is limited by its relatively short duration of action. In this review, we aim to summarize the evidence related to local anaesthetic adjuncts for peripheral nerve blockade. RECENT FINDINGS Dexamethasone and dexmedetomidine exhibit characteristics that most closely resemble the ideal local anaesthetic adjunct. In upper limb block, dexamethasone has been demonstrated to be superior to dexmedetomidine regardless of administration route for the duration of sensory and motor blockade as well as the duration of analgesia. No clinically significant differences between intravenous and perineural dexamethasone were found. Perineural and intravenous dexamethasone have the potential to prolong sensory blockade to a greater extent than motor blockade. The evidence indicates that the mechanism of action of perineural dexamethasone in upper limb block is systemic in nature. Unlike perineural dexmedetomidine, intravenous dexmedetomidine has not been shown to result in differences in the characteristics of regional blockade compared with local anaesthetic alone. SUMMARY Intravenous dexamethasone is the local anaesthetic adjunct of choice, increasing the duration of sensory and motor blockade as well as the duration of analgesia by 477, 289 and 478 min, respectively. In view of this, we recommend consideration of the intravenous administration of dexamethasone at a dose of 0.1-0.2 mg/kg for all patients undergoing surgery whatever the level of postoperative pain, mild, moderate or severe. Further research should focus on the potential synergism of action between intravenous dexamethasone and perineural dexmedetomidine.
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Affiliation(s)
- Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust
- King's College London, London, United Kingdom
| | - Eric Albrecht
- Department of Anaesthesia, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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24
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Marhofer P, Eichenberger U. Augmented reality in ultrasound-guided regional anaesthesia: useful tool or expensive toy? Br J Anaesth 2023; 131:442-445. [PMID: 37353469 DOI: 10.1016/j.bja.2023.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 06/25/2023] Open
Abstract
Use of augmented reality is increasingly applied in medical education and practice. The main advantage of this technology is the display of relevant information in the visual field of multiple operators. Here we provide a critical analysis of the potential application of augmented reality in regional anaesthesia.
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Affiliation(s)
- Peter Marhofer
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
| | - Urs Eichenberger
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
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25
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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: 0.5] [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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Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as an Adjuvant in Peripheral Nerve Block. Drug Des Devel Ther 2023; 17:1463-1484. [PMID: 37220544 PMCID: PMC10200118 DOI: 10.2147/dddt.s405294] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. It is the key to enhance clinical rehabilitation as an important part of the multimodal analgesia scheme. The emergence of ultrasound technology has accelerated peripheral nerve block technology development. It can directly observe the nerve shape, surrounding tissue, and diffusion path of drugs. It can also reduce the dosage of local anesthetics by improving positioning accuracy while enhancing the block's efficacy. Dexmedetomidine is a highly selective drug α2-adrenergic receptor agonist. Dexmedetomidine has the characteristics of sedation, analgesia, anti-anxiety, inhibition of sympathetic activity, mild respiratory inhibition, and stable hemodynamics. Numerous studies have revealed that dexmedetomidine in peripheral nerve blocks can shorten the onset time of anesthesia and prolong the time of sensory and motor nerve blocks. Although dexmedetomidine was approved by the European Drug Administration for sedation and analgesia in 2017, it has not yet been approved by the US Food and Drug Administration (FDA). It is used as a non-label drug as an adjuvant. Therefore, the risk-benefit ratio must be evaluated when using these drugs as adjuvants. This review explains the pharmacology and mechanism of dexmedetomidine, the effect of dexmedetomidine on various peripheral nerve block as an adjuvant, and compare it with other types of adjuvants. We summarized and reviewed the application progress of dexmedetomidine as an adjuvant in nerve block and look forward to its future research direction.
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Affiliation(s)
- Zheping Chen
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Zhenzhen Liu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Chang Feng
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Yanwu Jin
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xin Zhao
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
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27
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Yu L, Shen X, Liu H. The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:61. [PMID: 36849910 PMCID: PMC9969627 DOI: 10.1186/s12871-023-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Dexmedetomidine (DEX) has been thought to be an effective adjuvant to local anesthetics (LAs) in erector spinae plane block (ESPB), however, this method of use is not recorded in the drug instructions. Hence, our meta-analysis will evaluate its efficacy and safety for the first time. METHODS A systematic search of published articles was conducted in the PubMed, Embase, Web of science, and Cochrane Library databases up to July 17, 2022, using specific keywords related to our aims. The time first to request rescue analgesia, number of patient controlled intravenous analgesia (PCIA) presses, rate of rescue analgesia use, postoperative nausea and vomiting (PONV), arrhythmia, and hypotension were calculated by using random-effect models. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42022345488). RESULTS Numerous electronic databases were searched and finally 8 studies with a total of 570 patients, 303 in the DEX arm, 267 in the control arm were included. As an adjuvant to LAs, DEX significantly increased the time to first request of rescue analgesia (mean difference [MD] = 8.40, 95% confidence interval [CI] = 4.70-12.10, P < 0.00001), reduced the number of PCIA presses (MD = -4.12, 95% CI = -7.79 to -0.45, P = 0.03) and the rate of rescue analgesia (odds ratio [OR] = 0.33, 95% CI = 0.17-0.65, P = 0.002). Moreover, the combination reduced the risk of PONV (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). In addition, there was no difference in the incidence of hypotension (OR = 1.01, 95% CI = 0.37-2.74, P = 0.99) and arrhythmia (OR = 0.76, 95% CI = 0.19-3.07, P = 0.70). CONCLUSION DEX can reduce analgesic requirements after various surgical procedures when used as an adjuvant to LAs for ESPB. Moreover, there was no significant difference between the two groups in terms of safety indicators (arrhythmia, hypotension).
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
| | - Xiaojuan Shen
- 706A Ward, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China
| | - He Liu
- Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
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Hamed MA, Fargaly OS, Abdelghaffar RA, Moussa MA, Algyar MF. The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study. BMC Anesthesiol 2023; 23:53. [PMID: 36793000 PMCID: PMC9930274 DOI: 10.1186/s12871-023-02014-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Management of postoperative pain after shoulder arthroscopy is an important issue. Dexmedetomidine, as an adjuvant, improves nerve block efficacy and decreases postoperative consumption of opioids. As a result, we designed this study to determine if adding dexmedetomidine to an erector spinae plane block (ESPB) that is guided by ultrasound (US) is beneficial for treating immediate postoperative pain following shoulder arthroscopy. METHODS This randomized controlled double-blind trial recruited 60 cases 18-65 years old of both sexes, American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective shoulder arthroscopy. Random allocation of 60 cases was done equally into two groups according to the solution injected in US-guided ESPB at T2 before general anesthetic induction. Group (ESPB): 20 ml 0.25% bupivacaine. Group (ESPB + DEX): 19 ml bupivacaine 0.25% + 1 mL dexmedetomidine 0.5 µg/kg. The primary outcome was The total rescue morphine consumption in the first 24 postoperative hours. RESULTS The mean intraoperative fentanyl consumption was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) (82.86 ± 13.57 versus 100.74 ± 35.07, respectively, P = 0.015). The median (IQR) time of the 1st rescue analgesic request was significantly delayed in the group (ESPB + DEX) compared to group (ESPB) [18.5 (18.25-18.75) versus 12 (12-15.75), P = 0.044]. The number of cases that required morphine was significantly lower in the group (ESPB + DEX) than in the group (ESPB) (P = 0.012). The median (IQR) of total postoperative morphine consumption in 1st 24 h was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) [0 (0-0) versus 0 (0-3), P = 0.021]. CONCLUSION The dexmedetomidine as an adjuvant to bupivacaine in ESPB produced adequate analgesia by reducing the intraoperative and postoperative opioid requirements in shoulder arthroscopy. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov (NCT05165836; principal investigator: Mohammad Fouad Algyar; registration date: 21/12/ 2021).
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Affiliation(s)
- Mohamed Ahmed Hamed
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, 63511 Egypt
| | - Omar Sayed Fargaly
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, 63511 Egypt
| | | | | | - Mohammad Fouad Algyar
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
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Liu W, Guo J, Zheng J, Zheng B, Ruan X. Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial. BMC Anesthesiol 2022; 22:249. [PMID: 35931989 PMCID: PMC9354301 DOI: 10.1186/s12871-022-01791-6] [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: 10/02/2021] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose
Dexmedetomidine has been proposed as an additive to local anesthetics to prolong peripheral nerve block duration; however, perineural dexmedetomidine has been associated with an increased risk of bradycardia and hypotension This randomized controlled study investigated the effects of low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia. Methods Fifty-five patients who had undergone elective upper extremity surgery were randomized to receive an ultrasound-guided supraclavicular brachial plexus block with 20 mL 0.5% ropivacaine with or without 30 μg dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included the onset time and duration of the motor and sensory blocks, incidence of hypotension and bradycardia, total postoperative analgesics, and safety assessment during the 24 h after surgery. Results Dexmedetomidine significantly prolonged the duration of analgesia (887 ± 92 min vs 661 ± 83 min, P < 0.0001). The onset time and the duration of motor and sensory block were significantly different between the groups (all P < 0.001). No episodes of hypotension or bradycardia were detected in the dexmedetomidine group. The total postoperative analgesic use and side effect profiles in the first 24 h postoperative period were similar for both groups. Conclusions Low-dose dexmedetomidine (30 μg) as a perineural adjuvant significantly prolonged the analgesic duration of a brachial plexus block without inducing hemodynamic instability. Trial registration This trial was registered at ClinicalTrial.gov (NCT02630290).
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Affiliation(s)
- Wei Liu
- Department of Anesthesiology, School of Medicine, the Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, People's Republic of China
| | - Jingwen Guo
- Department of Anesthesiology, School of Medicine, the Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, People's Republic of China
| | - Jun Zheng
- Department of Anesthesiology, School of Medicine, the Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, People's Republic of China
| | - Bin Zheng
- Department of Anesthesiology, School of Medicine, the Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, People's Republic of China
| | - Xiangcai Ruan
- Department of Anesthesiology and Pain Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510665, China.
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Hu Z, Zhou Y, Zhao G, Zhang X, Liu C, Xing H, Liu J, Wang F. Effects of quadratus lumborum block on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. BMC Anesthesiol 2022; 22:213. [PMID: 35820804 PMCID: PMC9277940 DOI: 10.1186/s12871-022-01755-w] [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: 02/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. METHODS A total of 80 patients undergoing radical prostatectomy were randomly divided into two groups: general anaesthesia with QLB (QLB group; n = 40) and general anaesthesia with sham QLB (normal saline [NS] group; n = 40). QLB or sham QLB was performed before the induction of anaesthesia. Sufentanil was intravenously administered for postoperative analgesia. The primary outcome was the pain score (measured using a numerical rating scale [NRS]) at different time points within 48 h postoperatively. Secondary outcomes included the cumulative dose of sufentanil within 48 h postoperatively, subjective comfort, grip strength, first time of exhaustion, first fluid intake time, time to get out of bed, length of postoperative hospital stay and overall satisfaction. The SPSS software, version 17.0, was used for all statistical analyses. RESULTS Postoperative NRS at rest was significantly lower at 2 h (1.7 ± 1.1 versus 3.0 ± 2.1), 4 h (1.8 ± 1.2 versus 4.1 ± 2.3), 6 h (1.9 ± 2 versus 4.4 ± 2) and 12 h (3.5 ± 2.3 versus 5 ± 3.3) and was also lower when coughing at 2 h (2.3 ± 1.1 versus 4 ± 2.1), 4 h (2.3 ± 1. 1 versus 4.3 ± 2) and 6 h (2.4 ± 1.1 versus 5.9 ± 2.3) in the QLB than that in the NS group. The cumulative dose of sufentanil was significantly lower in the QLB than that in the NS group at 4 h, 6 h, 12 h, 24 h and 48 h. The nausea score was significantly lower in the QLB group at 24 h postoperatively, and the first time of exhaustion and time to get out of bed were significantly shorter (P < 0.05). The overall satisfaction score was significantly higher in the QLB than in the NS group (4 ± 0.7 versus 2.6 ± 0.9). CONCLUSION Ultrasound-guided bilateral QLB can provide effective postoperative analgesia for patients undergoing radical prostatectomy, reduce the need for sufentanil, facilitate comfort and improve postoperative outcomes. QLB can be a good component of multimodal analgesia. TRIAL REGISTRATION The clinical trial is registered in the Chinese Clinical Trial Registry (ChiCTR). Current Controlled Trials: ChiCTR1900022009 . the date of registration:2019/03/20.
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Affiliation(s)
- Zhen Hu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yingjie Zhou
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Guohao Zhao
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xinxin Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Chunchun Liu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Huan Xing
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Ji Liu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, Shanghai, 200072, People's Republic of China
| | - Fen Wang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China.
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Comparing Effect of Adding Ketamine versus Dexmedetomidine to Bupivacaine in Pecs-ⅠⅠ Block on Postoperative Pain Control in Patients Undergoing Breast Surgery. Clin J Pain 2022; 38:568-574. [PMID: 35777735 DOI: 10.1097/ajp.0000000000001055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pecs-II block has previously and successfully demonstrated a good quality of perioperative analgesia for breast surgery. OBJECTIVE This study aimed to compare the quality of postoperative pain control when adding either ketamine or dexmedetomidine to bupivacaine 0.25% for Pecs-II block. METHODS This prospective randomized double-blind study was conducted on 159 female patients with American society of anesthesiologist (ASA) physical status class I-III scheduled to have modified radical mastectomy. Patients were randomly assigned into three groups. Each group included 53patients to receive ultrasound guided Pecs-II blocks with either 32 mL of 0.25% bupivacaine added to ketamine hydrochloride 1 mg/kg (BK group), 32 mL of 0.25%bupivacaine added to dexmedetomidine 1 ug/kg (BD group) or 32 mL of 0.25% bupivacaine only (B group).The primary outcome of this study was the total postoperative morphine consumption for the first 24 hours postoperatively. The time of the first request of analgesia, the pain scores at rest of ipsilateral arm, and the intra-operative fentanyl requirements, were the secondary outcome measures. Any side effects occurred were recorded. RESULTS The total postoperative morphine consumption was significantly lower in patients received bupivacaine with addition of either ketamine (BK group), (10.3±2.6 mg), or dexmedetomidine (BD group), (3.8±0.2 mg) respectively, versus patients received only bupivacaine (B group), (16.9±5.3 mg). Both ketamine (BK group) and dexmedetomidine (BD group) added to bupivacaine significantly prolonged the time to first analgesic request (16.7±4.5 h), (21.6±1.6 h) in both groups respectively compared to patients received bupivacaine alone (B group), (11.5±1.2 h).The pain score was variable between the three groups over different times during the first 24 hours postoperatively. There was no significant difference in perioperative hemodynamics, O2 saturation, sedation scores or side effects observed between the three groups. Patient satisfaction was reported to be the best in patients received dexmedetomidine added to bupivacaine than the other patients who received ketamine as an additive or those who received bupivacaine alone. CONCLUSION Adding dexmedetomidine to bupivacaine provides more effective postoperative pain control than adding ketamine during Pecs-II blocks for breast cancer surgery.
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Aliste J, Layera S, Bravo D, Aguilera G, Erpel H, García A, Lizama M, Finlayson RJ, Tran D. Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. Reg Anesth Pain Med 2022; 47:rapm-2022-103760. [PMID: 35728840 DOI: 10.1136/rapm-2022-103760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND This randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block. METHODS Fifty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (2 mg) or combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg). After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), the onset time (defined as the time required to reach a minimal composite score of 14 points) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids or general anesthesia).Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block and postoperative analgesia. RESULTS No intergroup differences were observed in terms of success rate, onset time and surgical anesthesia. Compared with dexamethasone alone, combined dexamethasone-dexmedetomidine provided longer durations of motor block (21.5 (2.7) vs 17.0 (3.9) hours; p<0.001; 95% CI 2.6 to 6.4), sensory block (21.6 (3.6) vs 17.2 (3.6) hours; p<0.001; 95% CI 2.2 to 6.5), and postoperative analgesia (25.5 (9.4) vs 23.5 (5.6) hours; p=0.038; 95% CI 1.0 to 7.7). CONCLUSION Compared with perineural dexamethasone (2 mg) alone, combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg) results in longer durations of sensorimotor block and analgesia. Further studies are required to determine the optimal dosing combination for dexamethasone-dexmedetomidine. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT04875039.
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Affiliation(s)
- Julián Aliste
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Sebastián Layera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Daniela Bravo
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Germán Aguilera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Hans Erpel
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Armando García
- Department of Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
| | - Marcelo Lizama
- Department of Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
| | - Roderick J Finlayson
- Bill Nelems Pain and Research Center, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - D Tran
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Bao N, Shi K, Wu Y, He Y, Chen Z, Gao Y, Xia Y, Papadimos TJ, Wang Q, Zhou R. Dexmedetomidine prolongs the duration of local anesthetics when used as an adjuvant through both perineural and systemic mechanisms: a prospective randomized double-blinded trial. BMC Anesthesiol 2022; 22:176. [PMID: 35672660 PMCID: PMC9172023 DOI: 10.1186/s12871-022-01716-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background To study the respective peripheral and systemic mechanisms of action of dexmedetomidine, as adjuvant to regional anesthesia, we compared dexmedetomidine added to ropivacaine for mid-forearm nerve blocks, to either systemic-only dexmedetomidine, and to a control with no dexmedetomidine. Methods Sixty patients undergoing hand surgery were randomly divided into three groups (n = 20 per group). Each group underwent a triple-nerve (median, radial and ulnar) mid-forearm blocks with 0.75% ropivacaine. In the DexP group, 60 µg of dexmedetomidine were added to the anesthetic mixture, while in the DexIV group, they were intravenously infused. Normal saline as a placebo was used, either as adjuvant, or intravenously. All patients underwent also a supraclavicular block with 1.5% lidocaine for tourniquet pain. The main outcomes were the duration of analgesia and the duration of sensory blockade separately for each nerve termination of the upper limb, and the duration of motor blockade of the upper limb. Tolerance was assessed by blood pressure and heart rate, and the report of adverse events. Results Duration of analgesia was longer in the DexP group, in comparison to the two other groups (P < 0.001), while it was similar in the DexIV and the control group. For cutaneous territories targeted by the three mid-forearm blocks, the between-group differences behaved similarly. For the other cutaneous territories (musculocutaneous and posterior brachial cutaneous nerves), duration of sensory blockade was shorter in the control group than in the two dexmedetomidine groups. For duration of motor blockade, the between-group differences behaved similarly. Both blood pressure and heart rate were reduced in the DexP and the DexIV groups, compared to the control. Conclusions Dexmedetomidine used as an adjuvant to regional anesthesia may act mostly though a perineural mechanism, especially for the sensory aspects of anesthesia. A systemic action might however explain other clinical effects. Trial registration ChiCTR-IOR-17011149, date of registration: 16/04/2017
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Affiliation(s)
- Nana Bao
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China
| | - Kejian Shi
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China
| | - YiQuan Wu
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China
| | - Yuting He
- Department of Anesthesiology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Zhengjie Chen
- Department of Anesthesiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yuan Gao
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China
| | - Yun Xia
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Quanguang Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China.
| | - Riyong Zhou
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China.
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Wu Y, Kang Y, Li Y, Fu B. Impact of Ultrasound-Guided Deep Serratus Anterior Plane Block Combined With Dexmedetomidine as an Adjuvant to Ropivacaine Inpatient Quality of Recovery Scores Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial. Front Oncol 2022; 12:858030. [PMID: 35433468 PMCID: PMC9008730 DOI: 10.3389/fonc.2022.858030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 01/22/2023] Open
Abstract
BackgroundBreast cancer has overtaken lung cancer as the most commonly diagnosed malignancy and is the leading cause of cancer-related death in women. Surgery is the only possible cure for breast cancer, and the incidence of acute postoperative pain (APP) is high in breast surgery. Previous reports suggested that ultrasound-guided deep serratus anterior plane block (dSAPB) provided effective blockade to relieve pain after modified radical mastectomy for breast cancer. In fact, despite the long-acting local anesthetic agents used, the patient’s pain cannot completely be eliminated due to the short duration of anesthesia. Dexmedetomidine as an adjunct to local anesthetics can prolong peripheral nerve block duration. However, no study has investigated the role of dSAPB with dexmedetomidine in the quality of recovery scores undergoing modified radical mastectomy. Thus, this study was conducted aiming at this aspect.Material and MethodsThis single-center, double-blind, randomized clinical trial was conducted at Bethune International Peace Hospital. A total of 88 participants of elective modified radical mastectomy were enrolled from May and November 2021. Ultrasound-guided dSAPB combined with 30 ml of 0.375% ropivacaine or 30 ml of 0.375% ropivacaine with dexmedetomidine (1 μg/kg) was administrated before anesthesia at the fourth to fifth ribs of the axillary midline. The primary outcome was quality of recovery, measured 24 h postoperatively using the QoR-15. Secondary outcomes were the Visual Analogue Scale (VAS) scores at rest and movement at 1, 6, 12, 24, and 48 h after surgery, 48 h sufentanil consumption postoperatively, the incidence of postoperative nausea and vomiting (PONV), length of post-anesthesia care unit (PACU) stay, dizziness, delirium, SAPB-related adverse events, and patient’s satisfaction with pain management.ResultsAmong the 88 participants, 8 did not meet the inclusion criteria; the other 80 were randomized to receive dSAPB combined with ropivacaine (Group R, N=40) and dSAPB combined with ropivacaine plus DEX (Group RD, N=40), of which a total of 7 (4 in Group R and 3 in Group RD) were excluded due to protocol deviation. Eventually,73 participants (36 in Group R and 37 in Group RD) were included for final analysis, with age (SD, years, 54.08[6.28] vs. 54.62[7.44], p=0.740), body mass index (BMI) (SD, 27.96[1.67] vs. 27.57[2.38], p=0.428), and median preoperative global QoR-15 score (interquartile range (IQR), 127[123.25–131] vs. 126[121–130], p=0.662). The median postoperative global QoR-15 score (IQR, 107[103–112] vs. 109.5[107–114], p=0.016), VAS score at rest at 12th hour (IQR, 1[1–2] vs. 1[1–2], p=0.033), VAS score in movement at 12th hour (IQR, 2[1–3] vs. 2[1–3], p=0.014) and at 24th hour (IQR, 3[2–3] vs. 3[2–3], p=0.040), and median sufentanil rescues consumption (IQR, 14[12–17 vs. 14[12–15], p=0.022] of Group RD were significantly lower than those of the Group R. Patient satisfaction score (SD, 8.28[0.70] vs. 8.62[0.59], p=0.024) of Group RD were significantly higher than those of the Group R.ConclusionThe ultrasound-guided dSAPB combined with dexmedetomidine plus ropivacaine may improve the QoR-15 in patients undergoing modified radical mastectomy and indicates that it may be a useful intervention to aid recovery following breast cancer surgery. Furthermore, participants in the ropivacaine with DEX group met the superior pain relief in the early postoperative period, reduced postoperative cumulative opioid consumption, increased patient satisfaction, and no increase in the incidence of complications.
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Marhofer P, Harkanyi A, Hopkins PM. Regional anesthesia for shoulder surgery. Minerva Anestesiol 2022; 88:629-634. [PMID: 35164494 DOI: 10.23736/s0375-9393.22.16295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Regional anaesthesia should be the preferred technique for analgesia in shoulder surgery, which is a frequent procedure in the daily practice of anaesthesiologists. The use of ultrasound guidance enables the visualization of the relevant nerve structures and the adjacent anatomical details. Low volumes of local anaesthetics reduce the incidence of inadvertent blockade of the phrenic nerve with subsequent respiratory impairment. The additional administration of dexmedetomidine to local anaesthetics prolonges the duration of analgesia with a minimal increased incidence of haemodynamic side effects. An optimal workflow is associated with economical advantages due to an improved use of operation rooms. Attention have to be paid regarding intraoperative hypotension, cerebral hypoperfusion and complications due to positioning.
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Affiliation(s)
- Peter Marhofer
- Department of Anaesthesiology and Intensive Care Medicine, Orthopaedic Hospital Speising, Vienna, Austria - .,Department of Anaesthesiology, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria -
| | - Arpad Harkanyi
- Department of Anaesthesiology and Intensive Care Medicine, Orthopaedic Hospital Speising, Vienna, Austria
| | - Phil M Hopkins
- Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Guo H, Ao T, Wang J, Zhang X, Zheng J, Xiao Y, Xue R, Kalika P, Ran R. Clinical Efficacy of Perioperative Intravenous Dexmedetomidine and Lidocaine Combined Infusion for Thyroidectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Clin J Pain 2022; 38:264-270. [PMID: 35125385 DOI: 10.1097/ajp.0000000000001027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of perioperative dexmedetomidine (DEX) combined with lidocaine intravenous infusion on relieving postoperative pain and improving recovery for patients undergoing thyroidectomy. MATERIALS AND METHODS A total of 138 patients undergoing thyroidectomy with general anesthesia were randomly divided into 4 groups: lidocaine (1.5 mg/kg bolus followed by 2 mg/kg/h infusion) in the group L, DEX (0.5 µg/kg) in the group D, lidocaine (same as the group L) with DEX (0.5 µg/kg) in the group L+D, and placebo as normal saline in the group C. All drugs were infused until the end of the surgery. The visual analog scale (VAS) scores of patients at 1, 4, 8, 12, and 24 hours following surgery, opioid requirement, propofol consumption, incidence of postoperative nausea and vomiting, awaking time, hemodynamic variables, and any adverse effects were assessed. RESULTS Compared with the group C, the VAS scores in the group L+D were significantly lower until 8 hours after surgery (P<0.05), while the VAS scores were significantly decreased just until 4 hours in the group L and 1 hour in the group D after surgery (P<0.05). There was no significant difference in opioid consumption between 4 groups. Propofol consumption in the group L+D was significantly lower than other groups (P<0.05). Compared with the group C, the incidence of postoperative nausea and vomiting in the group L+D was lower (P<0.05), and awaking time in the group L+D and the group L was shorter (P<0.05). CONCLUSION DEX combined with lidocaine infusion can effectively attenuate the postoperative pain without any serious adverse events, which may improve postoperative recovery in patients undergoing thyroidectomy.
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Affiliation(s)
- Hao Guo
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Tingting Ao
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jiagao Wang
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xi Zhang
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Junwei Zheng
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yun Xiao
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Rui Xue
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Prakash Kalika
- Department of Critical Care Medicine, Om Hospital and Research Center, Kathmandu, Nepal
| | - Ran Ran
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Elshafie MA, Khalil MK, ElSheikh ML, Mowafy NI. Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial. Local Reg Anesth 2022; 15:1-10. [PMID: 35115825 PMCID: PMC8801329 DOI: 10.2147/lra.s343347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/08/2022] [Indexed: 01/01/2023] Open
Abstract
Background Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effect of erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection on perioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia and perioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery. Methods Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventional balanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6–7, the local anesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 µg/kg) on each side. We monitored hemodynamic stability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output). Results Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required. Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request for analgesia (p = 0.092) and decreased fentanyl requirement (p < 0.001), so no patient in the ESP group suffered from postoperative nausea and vomiting compared to 50% in the conventional group (p < 0.001). Conclusion Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patients undergoing liver resection.
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Affiliation(s)
- Minatallah A Elshafie
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
- Correspondence: Minatallah A Elshafie, Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt, Tel +20 111 224 8935, Email
| | - Magdy K Khalil
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Maha L ElSheikh
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Nagwa I Mowafy
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
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Nichols CL, Doherty TJ, Schumacher J, Jones PD, Sun X. Dexmedetomidine prolongs the duration of action of mepivacaine on anesthesia of the palmar digital nerves of horses. Am J Vet Res 2022; 83:114-118. [PMID: 34851852 DOI: 10.2460/ajvr.20.10.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether palmar digital nerve (PDN) blockade in horses with a combination of dexmedetomidine and mepivacaine would block the response to mechanical force applied to the digit longer than would anesthetizing these nerves with mepivacaine alone or dexmedetomidine alone. ANIMALS 8 mares with no signs of lameness. PROCEDURES In a randomized, crossover, blinded, experimental study, both PDNs of the same forelimb of each horse were anesthetized by perineural injection with either 30 mg mepivacaine alone, 250 µg of dexmedetomidine alone, or 30 mg mepivacaine combined with 250 µg of dexmedetomidine. Each horse received each treatment, and treatments were administered ≥ 2 weeks apart. The mechanical nociceptive threshold was measured at a region between the heel bulbs with the use of a digital force gauge before (baseline) and at 15-minute intervals after treatment. RESULTS The mean duration of sensory blockade of the digit was 2-fold longer when a combination of mepivacaine and dexmedetomidine was administered (371 minutes), compared with when mepivacaine alone was administered (186 minutes). Treatment with dexmedetomidine alone did not change the mechanical nociceptive threshold substantially from baseline and resulted in no clinical signs of sedation. CLINICAL RELEVANCE Results indicated that relief from digital pain provided by perineural treatment with mepivacaine for PDN blockade can be extended by adding dexmedetomidine to the injectate.
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Affiliation(s)
- Cailey L Nichols
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - James Schumacher
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Philip D Jones
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Xiaocun Sun
- Office of Information Technology, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
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Mahmoodiyeh B, Modir H, Moradi A, Mohseni F, Almasi-Hashiani A. Comparison of the efficacy of supraclavicular block with bupivacaine (0.5%) combined with dexmedetomidine, granisetron and magnesium sulphate in sensory and motor block and haemodynamic parameters of patients in upper-extremity orthopaedic surgery: A randomised clinical study. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_170_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Inagaki Y, Morita K, Ozaki M, Matsumoto K, Okayama A, Oya N, Hiraoka T, Takeda J. The Efficacy and Safety of Dexmedetomidine for Procedural Sedation in Patients Receiving Local Anesthesia Outside the Intensive Care Unit: A Prospective, Double-Blind, Randomized Clinical Phase III Trial in Japan. Yonago Acta Med 2022; 65:26-43. [DOI: 10.33160/yam.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/15/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Yoshimi Inagaki
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kiyoshi Morita
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama 700-8558, Japan
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka 350-1298; and Higashimatsuyama Medical Association Hospital, Higashimatsuyama 355-0021, Japan
| | - Akifumi Okayama
- Clinical Statistics Group 2, Biometrics & Data Management, Pfizer R&D Japan, Tokyo 151-8589, Japan
| | - Nobuyo Oya
- Clinical Development Department, Maruishi Pharmaceutical Co., Ltd., Osaka 538-0042, Japan
| | - Takehiko Hiraoka
- Clinical Development Department, Maruishi Pharmaceutical Co., Ltd., Osaka 538-0042, Japan
| | - Junzo Takeda
- Department of Anesthesiology, Keio University School of Medicine, Tokyo 151−8589, Japan; and National Hospital Organization, Tokyo Medical Center, Tokyo 152-8902, Japan
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Modir H, Nadimi-Bajandi H, Moshiri E, Parsi-Khamene M. Efficacy comparison of magnesium sulphate, ketamine and neostigmine adjuvants to bupivacaine 0.5% on onset, duration and quality of ultrasound-guided supraclavicular block characteristics for forearm surgery. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_159_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Jin XB, Xiao R, Zhou W, Liu C, Luo YR, Liu RH, Xu GH, Mei B, Xu JN, Yang R, Zhao D. Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty. Pain Ther 2021; 10:1649-1662. [PMID: 34595723 PMCID: PMC8586120 DOI: 10.1007/s40122-021-00320-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Dexmedetomidine (DEX) as a nerve block adjuvant can significantly prolong analgesia. However, whether perineural or systemic administration of DEX is more beneficial in patients undergoing total knee arthroplasty (TKA) has not been thoroughly investigated. To this end, we evaluated the effects of perineural and systemic DEX administration on postoperative analgesia in patients undergoing TKA surgery. METHODS We randomly assigned patients undergoing TKA under general anesthesia combined with femoral nerve block and sciatic nerve block to one of three groups: (1) ropivacaine plus perineural dexmedetomidine (DP): 0.25% ropivacaine 40 mL plus 0.5 μg/kg dexmedetomidine; (2) ropivacaine plus systemic dexmedetomidine (DS): 0.25% ropivacaine 40 mL plus systemic 0.5 μg/kg dexmedetomidine; (3) control group (C): 0.25% ropivacaine 40 mL. RESULTS The average length of time until patients first experienced postoperative pain was significantly longer in the DP group (26.0 h [22.0-30.0 h]) than in the DS group (22.4 h [18-26.8 h]) and the control group (22.9 h [19.5-26.3 h], P = 0.001). For this result there was no significant difference between the DS and the control group. Compared with the DS and control groups, patients in the DP group had lower resting visual analogue scale (VAS) scores at 24, 48, and 72 h after surgery (P < 0.05). VAS activity scores at 12, 24, and 48 h after surgery in the DP group were lower than those in the DS and control groups, with a statistically significant difference (P < 0.05). Compared with the DS and control groups, the amount of postoperative opioids in the DP group was also significantly reduced, and the number of people needing postoperative rescue analgesia was significantly lower, with a statistical difference (P < 0.05). Meanwhile, the sleep satisfaction of patients in the DP group on the first night after surgery and the satisfaction with pain control at 72 h after surgery were both higher than those in the DS group and control group (P < 0.05). CONCLUSIONS Perineural administration of DEX can significantly prolong the interval until patients report pain for the first time after TKA, relieve postoperative pain, reduce postoperative opioid dosage, and improve postoperative sleep quality and satisfaction with pain control. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry, identifier ChiCTR1900025808.
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Affiliation(s)
- Xiao-bin Jin
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China ,Department of Anesthesiology, Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022 Anhui China
| | - Rui Xiao
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Wei Zhou
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Chang Liu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Ya-ru Luo
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Rui-hong Liu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Guang-hong Xu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China ,Department of Neurology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Bin Mei
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jia-nan Xu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Rui Yang
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Dan Zhao
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
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Benzodiazepines safeguards nerve cells from the toxicity of lidocaine via miR-133a-3p/EGFR pathway. Transpl Immunol 2021; 71:101510. [PMID: 34856331 DOI: 10.1016/j.trim.2021.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lidocaine was an anesthetic commonly used for analgesia, but the neurotoxicity could not be ignored. However, benzodiazepines could alleviate the toxicity when combined with other drugs. PURPOSE To explore the molecular mechanism of benzodiazepines in protecting nerve cells after the induction of lidocaine. METHODS PC12 cells were induced by lidocaine (0 mM, 0.1 mM, 0.5 mM and 1 mM) first and then treated by benzodiazepines (0 μM-200 μM). RT-qPCR assays measured RNA expressions of epidermal growth factor receptor (EGFR) and microRNA-133a-3p (miR-133a-3p) in PC12 cell line, respectively. Western blot was for protein detections of EGFR and caspase-3. Flow cytometry assay assessed apoptosis and cellular viability was validated via Cell Counting Kit-8 (CCK-8) test. Bioinformatics analysis predicted the potential link between miR-133a-3p and EGFR and the binding was verified using the Dual luciferase reporter experiment. RESULTS Benzodiazepines increased cellular viability of PC12 cells up to 100 μM while suppressed viability between 100 and 200 μM. Benzodiazepines (0 μM, 10 μM, 50 μM and 100 μM) did not regulate PC12 cell viability but promoted the viability of lidocaine-treated PC12 cells. Lidocaine downregulated miR-133a-3p RNA expression but facilitated EGFR mRNA expression, which was reversed after treated by benzodiazepines. MiR-133a-3p targeted and negatively regulated EGFR expressions in mRNA and protein levels. Furthermore, miR-133a-3p inhibitor and overexpressed EGFR transfection both restrained the decreased PC12 cell viability and prompted cell apoptosis caused by benzodiazepines. CONCLUSION Benzodiazepines restrained lidocaine-induced toxicity in PC12 cells which secured viability and reduced apoptosis via miR-133a-3p/EGFR pathway.
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Reddy BS, Gaude YK, Vaidya S, Kini GK, Budania LS, Eeshwar MV. Effect of dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block with levobupivacaine-A prospective double-blind randomized controlled trial. J Anaesthesiol Clin Pharmacol 2021; 37:371-377. [PMID: 34759546 PMCID: PMC8562460 DOI: 10.4103/joacp.joacp_289_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/16/2019] [Accepted: 06/20/2019] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Levobupivacaine, a less cardiotoxic s-isomer of bupivacaine, is proved to be similar to bupivacaine, hence, proposed as a safer alternative for nerve blocks. We aimed to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block (BPB) performed with levobupivacaine. The aim of this study is to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular BPB performed with levobupivacaine. Material and Methods: A prospective, randomized double-blind control trial done on 120 patients undergoing elective upper limb surgical procedures under supraclavicular BPB. The enrolled patients were allocated to one of the three groups: Group L - 0.5% levobupivacaine +0.9% normal saline (NS) IV infusion; Group LDI - 0.5% levobupivacaine + dexmedetomidine (1 mcg/kg) in NS IV infusion; and Group LDP - 0.5% levobupivacaine +1 mcg/kg of dexmedetomidine perineural + NS IV infusion. The onset and duration of sensory and motor blockade were recorded in minutes. One-way ANOVA was used to observe any differences between the groups, and post hoc comparisons were conducted after Bonferroni correction for multiple comparisons. Results: The onset of sensory and motor blockade in Group LDP was significantly shorter than Group L and Group LDI. The duration of sensory blockade in Group LDP was significantly longer than Group LDI and Group L. The duration of motor blockade in Group LDP was prolonged compared to Group LDI and Group L. Conclusions: When dexmedetomidine is added as adjunct to levobupivacaine in supraclavicular BPB, onset of sensory and motor blockade is faster in perineural group, whereas duration of sensory and motor blockade and duration of analgesia are more prolonged when used perineurally than intravenously.
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Affiliation(s)
- Bhumireddy Suneel Reddy
- Department of Anaesthesiology, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India
| | - Yogesh K Gaude
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shriram Vaidya
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gurudas K Kini
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Lokvendra S Budania
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M V Eeshwar
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Goel CP, Desai S. Efficacy of dexmedetomidine as an adjuvant in femoral nerve block for post-op pain relief in hip surgery: A prospective randomized double-blind controlled study. J Anaesthesiol Clin Pharmacol 2021; 37:383-388. [PMID: 34759548 PMCID: PMC8562428 DOI: 10.4103/joacp.joacp_182_19] [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: 06/08/2019] [Revised: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: To determine whether the addition of dexmedetomidine either in peripheral block or via systemic route leads to prolongation of the duration of analgesia is inconclusive. The present study aimed to assess the duration of postoperative analgesia with dexmedetomidine used as an additive with bupivacaine for ultrasound-guided femoral nerve block (FNB) and to compare it with intramuscular dexmedetomidine along with FNB. Material and Methods: A prospective, double-blind randomized clinical trial involving adult patients undergoing elective hip surgery, performed under subarachnoid block. When sensory block receded to T12 after the surgery, FNB was given for postoperative analgesia. Patients were randomized into three groups; Group A received FNB with 40 mL 0.25% bupivacaine and 0.5 mL saline as IM injection, Group B received FNB with 39.5 mL of 0.25% bupivacaine + 0.5 mL (50 mcg) of dexmedetomidine in the affected limb and 0.5 mL saline IM injection, and Group C received FNB with 40 mL of 0.25% bupivacaine and 0.5 mL (50 mcg) of dexmedetomidine as IM injection. Postoperative pain was assessed and for pain with VAS score >3, intravenous tramadol was given as rescue analgesia. Chi-square test for categorical variables and one-way ANOVA for continuous variables. Results: The mean duration of analgesia in groups A, B, and C was 671, 676, and 490 min, respectively which was not significant. A 24 h analgesic requirement was also not different between the groups. Conclusion: The use of dexmedetomidine perineurally or systemically did not prolong the duration of analgesia as compared to bupivacaine alone for femoral nerve block.
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Affiliation(s)
- Chetna P Goel
- Department of Anesthesia, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Sameer Desai
- Department of Anesthesia, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
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Varsha R, Desai SN, Mudakanagoudar MS, Annigeri VM. Comparison between caudal epidural and ultrasound-guided ilioinguinal-iliohypogastric block with bupivacaine and dexmedetomidine for postoperative analgesia following pediatric inguinal hernia surgeries: A prospective randomized, double-blind study. J Anaesthesiol Clin Pharmacol 2021; 37:389-394. [PMID: 34759549 PMCID: PMC8562458 DOI: 10.4103/joacp.joacp_175_19] [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: 06/03/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background and Aims: Caudal epidural and ultrasound-guided ilioinguinal, iliohypogastric nerve (IL/IH) blocks are commonly used regional anesthesia techniques for postoperative analgesia in pediatric inguinal surgeries. Dexmedetomidine as an adjuvant has been proven to prolong the duration of both neuraxial and peripheral nerve blocks. We compared the duration of analgesia provided by local anesthetic (LA) and dexmedetomidine for caudal and IL/IH block for pediatric inguinal surgeries. Material and Methods: Forty-six children undergoing inguinal hernia repair were selected for this randomized double-blind study. After general anesthesia, children received either 0.75 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in caudal epidural or 0.25 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in IL/IH block. The pain was assessed up to 24 h postoperatively using face, legs, activity, cry, consolability (FLACC) score. For FLACC ≥4, rescue analgesia was provided using 1 μg/kg of intravenous fentanyl, up to 2 h postoperatively and 10 mg/kg of oral ibuprofen between 2 and 24 postoperative hours. The time for first rescue analgesia was taken as the duration of analgesia. Results: There were no significant differences in the pain scores or analgesic utilization between the groups. The duration of analgesia of caudal and IL/IH blocks was similar (720.3 ± 430.1 min and 808.4 ± 453.1 min, respectively). The time taken for the performance of block was significantly higher for caudal compared to IL/IH (547 ± 93 vs. 317 ± 179 s; P < 0.001). Conclusion: Both caudal epidural and USG-IL/IH block with dexmedetomidine as additive provide the comparable duration of postoperative analgesia with no significant side effects.
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Affiliation(s)
- R Varsha
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharawd, Karnataka, India
| | - Sameer N Desai
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharawd, Karnataka, India
| | | | - Venkatesh M Annigeri
- Department of Paediatric Surgery, SDM College of Medical Sciences and Hospital, Dharawd, Karnataka, India
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Acquafredda C, Stabile M, Lacitignola L, Centonze P, Di Bella C, Crovace A, Fiorentino M, Staffieri F. Clinical efficacy of dexmedetomidine combined with lidocaine for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Vet Anaesth Analg 2021; 48:962-971. [PMID: 34607765 DOI: 10.1016/j.vaa.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the effects of dexmedetomidine administered perineurally or intramuscularly (IM) on sensory, motor function and postoperative analgesia produced by lidocaine for sciatic and femoral nerve blocks in dogs undergoing unilateral tibial tuberosity advancement surgery. STUDY DESIGN Prospective, blinded, clinical study. ANIMALS A group of 30 dogs. METHODS Dogs were anaesthetized with acepromazine, propofol and isoflurane in oxygen/air. Electrolocation-guided femoral and sciatic nerve blocks were performed: group L, 0.15 mL kg-1 2% lidocaine (n = 10); group LDloc, lidocaine and 0.15 μg kg-1 dexmedetomidine perineurally (n = 10); group LDsys, lidocaine and 0.3 μg kg-1 dexmedetomidine IM (n = 10). After anaesthesia, sensory blockade was evaluated by response to forceps pinch on skin innervated by the saphenous/femoral, common fibular and tibial nerves. Motor blockade was evaluated by observing the ability to walk and proprioception. Analgesia was monitored with Short Form of Glasgow Composite Pain Scale for up to 4 hours after extubation. Methadone IM was administered as rescue analgesia. Data were analysed by linear mixed effect models and Kaplan-Meier test (p < 0.05). RESULTS Median duration of the sensory blockade for all nerves was longer (p < 0.001) for group LDloc than for groups L and LDsys and was longer (p = 0.0011) for group LDsys than for group L. Proprioception returned later (p < 0.001) for group LDloc [285 (221-328) minutes] compared with group L [160 (134-179) minutes] or LDsys [195 (162-257) minutes]. Return of the ability to walk was similar among all groups. Dogs in group LDloc required postoperative rescue analgesia later (p = 0.001) than dogs in groups LDsys and L. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine administered perineurally with lidocaine prolonged sensory blockade and analgesia during the immediate postoperative period. Systemic dexmedetomidine also prolonged the sensory blockade of perineural lidocaine.
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Affiliation(s)
- Claudia Acquafredda
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Paola Centonze
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Marco Fiorentino
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy.
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Nalawade SH, Nilesh K, Kumar CDM, Punde PA, Patil PB. A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars. Natl J Maxillofac Surg 2021; 12:255-261. [PMID: 34483586 PMCID: PMC8386254 DOI: 10.4103/njms.njms_7_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/08/2020] [Accepted: 06/19/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Dexmedetomidine is a selective alpha-2 adrenoceptor agonist. It is conventionally used as a sedative in the intensive care unit. However, recently, the application of dexmedetomidine as an adjuvant to a local anesthetic agent has been studied. The present study intends to evaluate the effectiveness of dexmedetomidine as an adjuvant to 2% plain lignocaine for surgical removal of impacted mandibular third molar and to compare the efficacy of dexmedetomidine with 2% plain lignocaine with 2% lignocaine and 1:200000 adrenaline. Materials and Methods A total of 80 patients who required surgical removal of impacted mandibular third molar extraction were included in the study. Patients were randomly divided into two groups using a computer-generated table. Patients in the study group received 2% plain lignocaine with 1 mcg/ml dexmedetomidine. Patients in the control group received 2% lignocaine with 1:200000 adrenaline. The parameters evaluated were onset and duration of action, pulse rate, blood pressure, oxygen saturation, and blood loss. Results Onset of action was faster and the duration of action was longer when dexmedetomidine was used with lignocaine as a local anesthetic agent. The vital parameters in both the groups were stable. Bleeding at the surgical site was less in the dexmedetomidine group. Conclusion The study concluded that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine when injected for nerve blocks.
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Affiliation(s)
| | - Kumar Nilesh
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Karad, Maharashtra, India
| | - C D Mounesh Kumar
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Karad, Maharashtra, India
| | - Prashant A Punde
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Karad, Maharashtra, India
| | - Pankaj B Patil
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Karad, Maharashtra, India
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Xiong C, Han CP, Zhao D, Tang ZH, Zhang YF, Wang J. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27064. [PMID: 34449500 PMCID: PMC10545042 DOI: 10.1097/md.0000000000027064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dexmedetomidine (Dexm), a selective alpha-2 adrenoceptor agonist, and dexamethasone (Dexa), a very potent and highly selective glucocorticoid, have both been proven effectively to prolong the duration of local anesthetics (LA) in regional anesthesia. However, data comparing the efficacy of Dexm and Dexa as perineural adjuvants are inconsistent. Therefore, this systematic review and meta-analysis of randomized and quasi-randomized controlled trials (RCTs) was conducted to compare the effects of Dexm and Dexa when used as LA adjuvants on peripheral nerve block (PNB). METHODS We systematically searched PubMed, Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up to October, 2020. The primary outcome was the duration of analgesia. Secondary outcomes included incidence of rescue analgesia, cumulative opioid consumption, time required for onset of sensory and motor blockades, duration of sensory and motor blockades, incidence of postoperative nausea and vomiting (PONV), and side effect-associated outcomes (e.g., bradycardia, sedation, hypotension, rates of infection, and neurological complications). The study was registered on PROSPERO, number CRD42020188796. RESULTS After screening of full-text relevant articles, 13 RCTs that met the inclusion criteria were retrieved for this systematic review. It was revealed that perineural Dexm provided equivalent analgesic duration to perineural Dexa. Besides, the intake of Dexm increased the incidence of rescue analgesia in limbs surgery, as well as the cumulative opioid consumption, and decreased the time required for onset of sensory and motor blockades for long-acting LA (all P < .05). Other analysis revealed insignificant difference between the 2 groups in terms of the incidence of PONV (P > .05). Additionally, 2 studies demonstrated that Dexm possesses more sedative properties than Dexa (P < .05). CONCLUSIONS This meta-analysis indicated that the analgesic duration of Dexm and Dexa as LA adjuvants in PNB is the same. Meanwhile, the effects of perineural Dexm and Dexa on some secondary outcomes, including the incidence of rescue analgesia, cumulative opioid consumption, and time required for onset of sensory and motor blockades, are associated with the surgical site and type of LA.
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Affiliation(s)
- Chang Xiong
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Cheng-peng Han
- Department of Rehabilitation, Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang, China
| | - Dong Zhao
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Zhi-hao Tang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yu-fan Zhang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Jian Wang
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
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Kumar CM, Chua AWY, Imani F, Sehat-Kashani S. Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review. Anesth Pain Med 2021; 11:e118271. [PMID: 34692445 PMCID: PMC8520679 DOI: 10.5812/aapm.118271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 01/28/2023] Open
Abstract
Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Alfred W. Y. Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saloome Sehat-Kashani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
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