Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia

Vieira, Antônio Mauro; Schnaider, Taylor Brandão; Brandão, Antônio Carlos Aguiar; Pereira, Flávio Aparecido; Costa, Everaldo Donizeti; Fonseca, Carlos Eduardo

doi:10.1590/s0034-70942004000400003

Cited by 21 publications

(4 citation statements)

References 7 publications

(12 reference statements)

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“…Some of the studies have noted dexmedetomidine-associated decreases in heart rate and blood pressure 8,34 and increased sedation. 32,33 The other four studies found no differences in side effects associated with dexmedetomidine. The sedation associated with intravenous dexmedetomidine has been termed “cooperative sedation,” which may mean that any sedation from perineural administration may be beneficial, especially when compared with the type of sedation associated with benzodiazepines and opioids.…”

Section: Discussionmentioning

confidence: 88%

Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current

et al. 2011

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Background The present study was designed to test the hypothesis that the increased duration of analgesia caused by adding dexmedetomidine to local anesthetic results from blockade of the hyperpolarization-activated cation (Ih)current. Methods In this randomized, blinded, controlled study, the analgesic effects of peripheral nerve blocks using 0.5% ropivacaine alone or 0.5% ropivacaine plus dexmedetomidine (34 μM or 6 μg/kg) were assessed with or without the pretreatment of α1- and α2-adrenoceptor antagonists (prazosin and idazoxan, respectively) and antagonists and agonists of the Ih current (ZD 7288 and forskolin, respectively). Sciatic nerve blocks were performed, and analgesia was measured by paw withdrawal latency to a thermal stimulus every 30 min for 300 min post-block. Results The analgesic effect of dexmedetomidine added to ropivacaine was not reversed by either prazosin or idazoxan. There were no additive or attenuated effects from the pretreatment with ZD 7288 (Ih current) when compared with dexmedetomidine added to ropivacaine. When forskolin was administered as a pretreatment to ropivacaine plus dexmedetomidine, there were statistically significant reductions in duration of analgesia at time points 90–180 min (p < 0.0001 for each individual comparison). The duration of blockade for the forskolin (768 μM) followed by ropivacaine plus dexmedetomidine group mirrored the pattern of the ropivacaine alone group, thereby implying a reversal effect. Conclusion Dexmedetomidine added to ropivacaine caused approximately a 175% increase in the duration of analgesia, which was reversed by pretreatment with an Ih current enhancer. The analgesic effect of dexmedetomidine was not reversed by an ∝2-adrenoceptor antagonist.

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Section: Discussionmentioning

confidence: 88%

Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current

et al. 2011

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“…Dexmedetomidine, although currently approved for IV use only, has been successfully used in neuraxial blocks in experimental and clinical studies without neurological deficits encouraging its use by the epidural route. [ 13 19 20 21 ] Nevertheless, there are still some concerns regarding its safety. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block

et al. 2016

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Context:Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia.Aim:We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries.Settings and Design:Double-blinded randomized controlled trial.Materials and Methods:Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 μg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h.Results:The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects.Conclusion:Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects.

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“…Dexmedetomidine, an α 2 -agonist for α 2 -adrenergic receptors, possesses sedative and analgesic properties without respiratory depressant effect [1] and enhances their effects without increasing the incidence of side effects when added to local anesthetic agents [2–8]. At present, dexmedetomidine, although approved for intravenous use only, has been successfully used in neuraxial block and epidural block in experimental and clinical studies with less side effects [9, 10]. However, the study of dexmedetomidine is scarce in the obstetric population, and the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain.…”

Section: Introductionmentioning

confidence: 99%

Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study

Zhang

Ming

2017

Evidence-Based Complementary and Alternative Medicine

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Background Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. Methods One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0.25, 0.5, 0.75, and 1 μg/ml of dexmedetomidine plus 0.1% ropivacaine, resp.). The onset of epidural anesthesia and stages of labor were studied, and pain was assessed using a visual analogue scale (VAS). Hemodynamic parameters and fetal heart rate were monitored. Apgar scores and umbilical artery pH were recorded. The side effects, if any, were recorded also. Results The addition of 0.25, 0.5, and 0.75 μg/ml of dexmedetomidine to 0.1% ropivacaine provided safe and effective analgesia, but 1 μg/ml of dexmedetomidine resulted in increasing incidence of motor block. The hemodynamic parameters were similar between groups (P > 0.05). Side effects in Group D were significantly higher than those in the other three groups (P < 0.05). Conclusions When dexmedetomidine is combined with 0.1% ropivacaine, the optimal concentration of dexmedetomidine is 0.5 μg/ml for epidural labor analgesia (this trial is registered with ChiCTR-OPC-16008548).

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Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia

Cited by 21 publications

References 7 publications

Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current

Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current

Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block

Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study

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