Background
The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus dexmedetomidine and ketamine for sedation during awake fibreoptic intubation (FOI) in patients posted for elective surgeries. Ninety-eight American Society of Anesthesiologists Physical Status (ASA-PS) I–II patients with difficult airway and scheduled for elective surgeries were enrolled in this study after institutional ethics committee approval. Patients were randomly allocated into 2 groups, i.e. 49 patients in each group. Group D patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline followed by a continuous infusion at 0.5 μg/kg/h till FOI and 5-mL normal saline followed by saline infusion. Group DK patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline. Further, they received IV ketamine 15 mg as a bolus of 5 mL, followed by continuous infusion of ketamine at 20 mg/h until the end of intubation. The primary objective was to compare the efficacy of the combination of IV dexmedetomidine and ketamine with IV dexmedetomidine alone as sedation for FOI. Vocal cord movement, sedation, coughing, facial grimace score, recall of procedure, and haemodynamics were also compared in both groups.
Results
Demographic data, vocal cord movement, cough score, facial grimace score, total drugs used, hoarseness, sore throat and level of recall were comparable in both groups. Haemodynamics were significantly better in group DK at 2, 3, 4 and 5 min compared to group D.
Conclusions
Addition of ketamine to dexmedetomidine did not improve intubating conditions, reduce cough or improve recall of FOI. However, patients remain sedated when ketamine was used with dexmedetomidine. The study was not registered prospectively in any clinical trial registry.
<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> < 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.
Background
Total knee arthroplasty (TKA) causes significant postoperative pain, imposing a limitation on postoperative mobilization crucial in regaining joint function. Ultrasound (US)-guided femoral nerve block (FNB) in complex knee surgeries is associated with better pain scores and fewer hospital admissions. Alpha-2 (α2) adrenoreceptor agonists have been the recent focus of interest as additives to local anesthetic. We aimed to compare the equivalent dose of dexmedetomidine and clonidine as an adjuvant to ropivacaine in US-guided FNB in TKA. A prospective, randomized, controlled, double-blinded study was conducted involving 80 American Society of Anesthesiologists’ physical status (ASA-PS) I, II, and III patients scheduled to undergo TKA under subarachnoid block. Group 1 (n = 40) patients received 1 μg/kg dexmedetomidine and group 2 (n = 40) patients with 1 μg/kg clonidine as adjuvants added to 20 ml of 0.75% ropivacaine. Duration of postoperative analgesia, pain scores, sedation scores, hemodynamics, rescue analgesia requirement, complications, and patient satisfaction were compared.
Results
The total duration of analgesia in group 1 was better compared to group 2 (p < 0.001).
The patients were better sedated and the mean NRS scores were significantly lower (p < 0.05) in group 1 up to 24 h postoperatively. Total analgesic consumption was reduced in group 1, with a p value < 0.001. Patient satisfaction was significantly better (p < 0.001) in group 1 compared to group 2.
Conclusion
We conclude that dexmedetomidine added as an adjuvant in FNB increased the duration of analgesia when compared to clonidine with decreased NRS scores, reduced postoperative tramadol requirement, and better sedation and patient satisfaction.
Trial registration
Researchregistry6709, “Retrospectively registered” on 31 March 2021.
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