A Randomized Double-Blind Trial Comparing the Efficacy of Dexamethasone vs. Clonidine as an Adjunct to Ropivacaine in Ultrasound Guided Continuous Interscalene Block for Arthroscopic Shoulder Surgery

Taneja, Vaibhav; Mitra, Sukanya; Singh, Jasveer; Jindal, Swati; Gupta, Roshan

doi:10.26420/austinjanesthesiaandanalgesia.2021.1102

Cited by 2 publications

(13 citation statements)

References 30 publications

(50 reference 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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“…Three study [24,29,30] displayed high risk of bias arising from selection, performance, detection, and attrition. The remaining 6 articles had unclear risks of bias [13,14,18,26–28] . The outcomes of risk assessment are presented in Fig.…”

Section: Results Of the Meta-analysis For Outcomesmentioning

confidence: 99%

“…Five hundred forty seven studies were identified during our first search, among which 83 duplicates were removed after assessment. Through thorough review of the titles, abstracts, and full texts, 13 RCTs [13][14][15][16][17][18][24][25][26][27][28][29][30] were eventually selected for the final analysis. The flowchart of the study selection is shown in Fig.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…To date, studies have shown that Dexm and Dexa are the 2 most frequently used adjuvants for LA. They can significantly prolong postoperative analgesic duration, reduce intake of opioids, and their use is associated with a limited number of side effects [13–15] . However, there are conflicting reports regarding the overall efficacy of the 2 additives as adjuvants in LA [16–18] …”

Section: Introductionmentioning

confidence: 99%

“…They can significantly prolong postoperative analgesic duration, reduce intake of opioids, and their use is associated with a limited number of side effects. [13][14][15] However, there are conflicting reports regarding the overall efficacy of the 2 additives as adjuvants in LA. [16][17][18] Motivated by this controversy, this systematic review and meta-analysis aimed to assess the comparative analgesic efficacy of Dexm and Dexa to light.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block

Xiong

Han²,

Zhao

et al. 2021

Medicine

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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.Abbreviations: Dexa = dexamethasone, Dexm = dexmedetomidine, LA =local anesthetics, PNB = peripheral nerve block, PONV = postoperative nausea and vomiting, RCTs = randomized controlled trials.

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A Randomized Double-Blind Trial Comparing the Efficacy of Dexamethasone vs. Clonidine as an Adjunct to Ropivacaine in Ultrasound Guided Continuous Interscalene Block for Arthroscopic Shoulder Surgery

Cited by 2 publications

References 30 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

Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block

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