Association of clonidine and ropivacaine in brachial plexus block for shoulder arthroscopy

Faria-Silva, Raphael; Rezende, Daniel Câmara de; Ribeiro, Juarez Mundim; Gomes, Telmo Heleno; Oliveira, Braulio Antônio Maciel Faria Mota; Pereira, Fábio Maciel R.; Filho, Ildeu Afonso de Almeida; Carvalho, Antônio Enéas Rangel de

doi:10.1016/j.bjane.2013.06.022

Cited by 9 publications

(17 citation statements)

References 28 publications

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“…in two different studies found clonidine reduced PONV in an appreciable manner by an opioid-sparing effect. [ 27 28 ] In our study, we had similarly found less nausea, vomiting, shivering in clonidine-treated group.…”

Section: Discussionsupporting

confidence: 74%

“…Similar findings were evidenced by Faria-Silva et al ., who conducted shoulder arthroscopic surgeries under brachial plexus block and found clonidine mixed local anesthetic group asked for morphine as rescue analgesic much later and in lesser amount. [ 27 ] Gupta et al . also demonstrated similar findings while clonidine was used in epidural route for knee replacement surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Effect of clonidine as adjuvant in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, placebo-controlled, double-blind study

et al. 2017

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Background and Aims:Postoperative pain after breast cancer surgery is unavoidable. Thoracic paravertebral block (TPVB), a locoregional anesthetic technique, has been proven successful for postoperative pain management in different thoracic surgical procedures, such as thoracotomy, breast cancer surgeries. Clonidine, an adjuvant, in TPVB may enhance the quality and prolong the duration of analgesia. This prospective study was to evaluate the effectiveness of clonidine; administered with TPVB; in addition to conventional local anesthetic solution.Materials and Methods:Fifty-two patients (25–55 years) scheduled for breast cancer surgery under general anesthesia were randomly divided into Group A (n = 26) receiving preoperative TPVB at T3 with clonidine added to local anesthesia solution and Group B (n = 26) receiving identical TPVB with local anesthesia but without any adjuvant. This was followed by balanced general anesthesia. A visual analog scale was used to assess pain postoperatively up to 48 h. Meantime to administration of the first dose of rescue analgesic was noted. Total dose of fentanyl consumption, hemodynamic parameters, and side effects were all recorded for each patient.Results:The dosage of fentanyl required in the intraoperative period was significantly lower in Group A. Mean time to administration of rescue analgesic was found to be significantly longer in clonidine group. Hemodynamics and side effects were quite comparable among two groups.Conclusion:Clonidine as adjuvant in TPVB provided profound analgesia for up to 48 h postoperatively for patients undergoing breast cancer surgery without any appreciable side effects.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Effect of clonidine as adjuvant in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, placebo-controlled, double-blind study

et al. 2017

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“…To describe higher pain levels, the scales used 14 different anchors in total ( Figure 2 ) with “worst pain imaginable” [ 11 , 12 , 15 , 26 , 36 , 38 , 43 , 48 , 51 , 54 ] being the preferred anchor. The second most frequent anchor was “worst pain” [ 10 , 28 , 33 , 34 ] and then successively “most severe pain imaginable” [ 19 , 20 , 37 ], “severe pain” [ 18 , 32 , 46 ], and “worst possible pain” [ 29 , 41 , 47 ]. Twelve studies did not report the used anchors [ 13 , 16 , 17 , 27 , 31 , 35 , 40 , 49 , 50 , 55 – 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Some studies used more than one method due to variations in analgesic protocols, such as different scheduled analgesics and rescue analgesics. In most cases, only the rescue analgesics were recorded (in mg or number of doses) [ 14 , 21 , 24 , 47 , 49 ], or the number of patients requesting [ 34 , 54 , 56 ] (or not requesting) analgesics [ 19 ]. For patients using patient-controlled analgesia (PCA, usually with intravenous opioid), the number of attempts, number of doses, and/or cumulated dose (for example during 24 hours) were reported [ 31 , 37 , 41 , 48 , 50 , 52 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…For patients using patient-controlled analgesia (PCA, usually with intravenous opioid), the number of attempts, number of doses, and/or cumulated dose (for example during 24 hours) were reported [ 31 , 37 , 41 , 48 , 50 , 52 , 57 ]. Some studies reported total consumption of morphine/opioids [ 12 , 13 , 47 ] or cumulated amount of all analgesics [ 10 , 15 ] during a specific period of time.…”

Section: Resultsmentioning

confidence: 99%

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Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment

Rasmussen

Nikolajsen

Bjørnholdt

2018

SICOT-J

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Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature.Methods: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017.Results: A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors “no pain” and “worst pain imaginable”, with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used.Discussion: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.

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Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

Paul

Szukics

Brutico

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To provide an updated review of multimodal pain management in arthroscopic surgery by evaluating pain and opioid consumption after shoulder, knee, and hip arthroscopy. Methods: A comprehensive literature search was performed to identify randomized controlled trials (RCTs) investigating multimodal pain management after shoulder, knee, and hip arthroscopy. Articles were identified from January 2011 through December 2020 using various databases. As the primary outcome variables of this study, differences in postoperative pain and opioid consumption volumes were summarized from all reported postoperative time points. Results: 37 shoulder, 28 knee, and 8 hip arthroscopy RCTs were included in the study. The most frequent bias present in the included RCTs was incomplete outcome data (58%), while group allocation concealment was the least frequent bias (15%). Qualitative analysis of rotator cuff repair (n ¼ 12), anterior cruciate ligament reconstruction (n ¼ 11), meniscectomy (n ¼ 5), femoroacetabular impingement (n ¼ 2), oral medications (n ¼ 8), postoperative interventions (n ¼ 10), and nonpharmacological interventions (n ¼ 6) was performed. Conclusions: Many multimodal pain management protocols offer improved pain control and decreased opioid consumption after arthroscopic surgery. On the basis of the current literature, the evidence supports an interscalene nerve block with a dexamethasone-dexmedetomidine combination for rotator cuff repair, a proximal continuous adductor canal block for anterior cruciate ligament reconstruction, and local infiltration analgesia (e.g., periacetabular injection with 20 mL of .5% bupivacaine) for hip arthroscopy. When evaluating oral medication, the evidence supports 150 mg Pregabalin for shoulder arthroscopy, 400 mg Celecoxib for knee arthroscopy, and 200 mg Celecoxib for hip arthroscopy, all taken preoperatively. There is promising evidence for the use of various nonpharmacological modalities, specifically preoperative opioid education for rotator cuff repair patients; however, more clinical trials that evaluate nonpharmacological interventions should be performed.

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Association of clonidine and ropivacaine in brachial plexus block for shoulder arthroscopy

Abstract: The use of brachial plexus block with local anesthetic for analgesic postoperative control is well established in the literature. The addition of clonidine in the dose proposed for prolongation of the analgesic effect and reduction of opioid rescue proved unhelpful.

Cited by 9 publications

References 28 publications

Effect of clonidine as adjuvant in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, placebo-controlled, double-blind study

Effect of clonidine as adjuvant in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, placebo-controlled, double-blind study

Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment

Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

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