Background:Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB).Methods:A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers.Results:Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], −3.86 minutes, 95% CI −5.45 to −2.27 minutes; I2 = 85%) and motor (MD, −5.21 minutes; 95% CI −7.48 to −2.94 minutes; I2 = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87–269.52 minutes; I2 = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48–230.91 minutes; I2 = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes; I2 = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI −0.02 to 0.05, I2 = 45%; P = .45) and hypotension (RD, 0.01, 95% CI −0.01 to 0.03, I2 = 0%; P = .57) between 2 groups.Conclusion:Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.

No abstract

Purpose To assess the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block in controlling postoperative pain and promoting recovery of lower extremity after total hip arthroplasty (THA), and to compare its effectiveness with supra-inguinal fascia iliaca compartment block (S-FICB). Materials and methods 92 patients undergoing THA with general anesthesia were randomly allocated to receive either a PENG with LFCN block (n = 46) using 30 ml 0.33% ropivacaine (20 ml for PENG block, 10 ml for LFCN block), or an S-FICB (n = 46) using 30 ml 0.33% ropivacaine. The primary outcome was the time to first postoperative walk. The secondary outcomes included intraoperative remifentanil consumption, postoperative hip flexion degree and muscle strength of the operative lower limbs in the supine position, pain scores (static and dynamic), rescue analgesia, postoperative nausea and vomiting (PONV), and nerve block-related complications. Results The combination of PENG with LFCN blocks resulted in an earlier first postoperative walking time (19.6 ± 9.6 h vs 26.5 ± 8.2 h, P < 0.01), greater postoperative hip flexion degree at 6 h, 24 h and 48 h (all P < 0.01), and higher muscle strength of the operative lower limbs at 6 h after surgery (P = 0.03) compared to S-FICB. The difference in pain scores (static and dynamic) was only statistically significant at 48 h (P < 0.05). There were no differences in the other outcomes. Conclusions PENG with LFCN blocks is more effective than S-FICB in shortening the time to first postoperative walk and preservation hip motion after THA, which makes it a suitable addition to enhanced recovery programs following surgery.

Background Hip arthroplasty is effective in treating hip diseases, such as osteoarthritis and hip fracture, but it often brings severe trauma and pain. In recent years, ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB) has become a widely used nerve block method for analgesia in hip arthroplasty. Methods Fifty-three patients preparing for hip arthroplasty were prospectively enrolled. S-FICB was performed under ultrasound guidance, and inject 0.33% ropivacaine into the space. Using the biased-coin design (BCD) sequential allocation method. The initial volume of 0.33% ropivacaine was 30ml. In case of failure, the next patient received a higher volume (defined as the previous volume with an increment of 1.2 mL). If the previous patient had a successful block, the next patient was randomized to a lower volume (defined as the previous volume with a decrement of 1.2 mL), with a probability of b = 0.05, or the same volume, with a probability of 1 − b = 0.95. The study was stopped when 45 successful blocks were achieved. Results Forty-five patients (84.9%) were blocked successfully. The 95% effective volume (EV95) was 34.06ml (95%CI 33.35 ~ 36.28ml). There were 31 patients with non-fracture in this study. The quadriceps muscle strength decreased in only two patients. Moreover, they both received 34.8ml of ropivacaine for S-FICB. Twenty-two patients had hip fractures. There were 3 patients (14%) with failed blocks and 19 patients (86%) with successful blocks. However, all fracture patients experienced less pain after S-FICB. Conclusion EV95 of 0.33% ropivacaine for ultrasound-guided S-FICB was 34.06ml. Trial registration The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100052214, registration date: 2021 October 22).

Ultrasound-guided thoracic paravertebral block (TPVB) has become increasingly popular for postoperative analgesia after thoracic surgery. We designed this prospective, randomized, double-blind, placebo-controlled trial to investigate the effect of TPVB on blood coagulation in patients after thoracoscopic lobectomy. Patients and Methods: Sixty patients scheduled for thoracoscopic lobectomy were randomly allocated to two groups. Patients underwent ultrasound-guided TPVB with 0.33% ropivacaine (T group) or 0.9% saline (C group) at the end of the surgery under general anesthesia. Patient-controlled intravenous analgesia (PCIA) was administered for both group after the surgery. The primary outcome was the thromboelastogram (TEG) parameters before anesthesia (T0), at the end of operation (T1) and in 1 day (T2) and 2 days (T3) after the operation, the second outcomes were the analgesic effect and the amount of intraoperative opioid consumption, operation time, infusion volume, blood loss and urine volume. Results:The visual analog scale (VAS) scores in group T were lower than group C (P < 0.05). In group T, compared with T0, the R value at T1 and T2 is significantly reduced, and the K value at T1 were significantly shortened, the α-angle and MA value at T1 were significantly increased (P < 0.05). In group C, compared with T0, the R value and K value were significantly shortened, the α-angle and MA value were significantly increased at all postoperative time points (P < 0.05). Compared with group C at the same time point, the R and K values of group T were significantly longer, and the α-angle and MA values were significantly reduced at T2 and T3 points, with statistically significant differences (P<0.05). Conclusion: TPVB is beneficial to improve postoperative hypercoagulability and promote postoperative rehabilitation of patients after thoracoscopic lobectomy.