Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

Ghasemi, Ali; Chamanara, Mohsen; Paknejad, Babak; Yousefizoshk, Mojtaba; Hazrati, Ebrahim

doi:10.1016/j.bjane.2021.03.026

Cited by 5 publications

(10 citation statements)

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“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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“…It successfully prolongs the duration of sensory and motor blockade and duration of analgesia when used as adjuvant to local anesthetics. [2][3][4][5][6] The mechanism of action may be due to its vasoconstrictive property, alteration in locus ceruleus activity decreasing release of norepinephrine. Systemic absorption of drug from injection site results its action over the alpha 2 adrenergic receptors in dorsal horn and reduces the release of pain mediating substances.…”

Section: Discussionmentioning

confidence: 99%

“…4 Many adjuvant drugs such as opioids, α agonists, steroids, and vasoconstrictor agents have been co-administered in BPB with local anesthetic (LA) agents to improve the block quality or duration of analgesia with varying degree of outcome. 2,[4][5][6][7] Bupivacaine is used frequently for supraclavicular BPB as it has long duration of action from 6 to 12 h. In spite of that, it fails to provide faster onset and prolong postoperative analgesia when used alone. Fentanyl, a synthetic, lipophilic, and potent opioid is known to have an antinociceptive effect which may be mediated via activation of peripheral opioid receptor.…”

Section: Introductionmentioning

confidence: 99%

“…The addition of opioid in BPB is reported to improve success rate, post-operative analgesia and also reduce systemic side effects and total dose of anesthetic required. 5,6,[8][9][10][11][12][13] Alpha-2 adrenergic receptor agonists have been the focus of interest for their dose dependent sedation, anxiolysis, analgesia, perioperative sympatholysis and cardiovascular stabilizing effects with reduced anesthetic requirement. Various methods of administration of alpha-2 adrenergic receptor agonists such as epidural, intrathecal, and peripheral injections have been tried either alone or in combination with another drug to prolong the duration of analgesia and intensify the anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study

2022

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Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb. Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB. Materials and Methods: A prospective, randomized, and triple-blind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 μg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 μg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P<0.001). The duration of post-operative analgesia was also longer in the BD Group compared with the BF Group (549.43±10.56 vs. 403.69±10.84) P<0.001. BF Group had more requirements of analgesic postoperatively. Conclusion: Addition of dexmedetomidine to bupivacaine prolonged the duration of perineural supraclavicular BPB and improvement of post-operative analgesia than fentanyl without significant side effects in patients undergoing upper limb surgeries.

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“…Dexmedetomidine is an α2 agonist that can be used for intravertebral and peripheral nerve anaesthesia with better sedation and analgesia, preserving the patient's voluntary respiration as well as inhibiting sympathetic activity 13,14 . Because of its high safety, it is often used in combination with local anaesthetics in clinical anaesthesia work, which can prolong the action time of local anaesthetics and reduce its dosage 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Utility of dexmedetomidine on surgical site wound pain undergoing thoracoscopic surgery: A meta‐analysis

Li,

Zhang,

et al. 2023

International Wound Journal

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We conducted this study aimed to evaluate the analgesic effect of dexmedetomidine in thoracoscopic surgery on postoperative wound pain, and to provide a reference for clinical use of the drug. We searched PubMed, Embase, Cochrane Library, Web of Science, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure databases, and supplemented with manual searching. We searched from database inception to October 2023, to collect the randomised controlled trials (RCTs) on dexmedetomidine application in thoracoscopic surgery. Two researchers screened all the literature according to the inclusion and exclusion criteria and the literature included in the study was evaluated for quality, extracted information and required data. Stata 17.0 software was employed for data analysis and the outcomes were 2 6, 12, 24 and 48 h postoperative wound visual analog scores (VAS). Twenty‐four RCTs totalling 2246 patients undergoing thoracoscopic surgery were finally included. The analysis revealed dexmedetomidine applied to thoracoscopic surgery significantly reduced the postoperative wound VAS scores at 2 h (SMD: −0.96, 95% CI: −1.57 to −0.36, p = 0.002), 6 h (SMD: −0.98, 95% CI: −1.27 to −0.69, p < 0.001), 12 h (SMD: −1.19, 95% CI: −1.44 to −0.94, p < 0.001), 24 h (SMD: −0.91, 95% CI: −1.16 to −0.66, p < 0.001) and 48 h (SMD: −0.75, 95% CI: −1.02 to −0.48, p < 0.001). Our results suggest dexmedetomidine applied to thoracoscopic surgery can significantly reduce postoperative wound pain, which is worthy of clinical application.

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Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

Cited by 5 publications

References 28 publications

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study

Utility of dexmedetomidine on surgical site wound pain undergoing thoracoscopic surgery: A meta‐analysis

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