Comparison of ultrasound guided interscalene brachial plexus block using 0.2% ropivacaine with dexmedetomidine and 0.2% ropivacaine with dexamethasone - A prospective observational study

Shekar, M; Kanakalakshmi, Sushma Thimmaiah; Mathew, Sheena; Muhamed, Shiyad; Duggappa, Arun Kumar Handigodu; Herekar, Basavaraj

doi:10.4038/slja.v28i2.8574

Cited by 2 publications

(10 citation statements)

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“…In order to prolong the time of single nerve block analgesia, more and more anesthesiologists add adjuvants to local anesthetics (LAs) [ 3 ]. Over the past decade, adjuvants of local anesthetics such as opioids [ 4 ], epinephrine [ 5 ], clonidine [ 6 ], magnesium [ 7 ], midazolam [ 8 ], dexamethasone [ 9 ], buprenorphine [ 10 ] and dexmedetomidine (DEX) [ 11 ] have been proved to prolong the analgesic time of nerve block, and have achieved varying degrees of success. Among these different kinds of adjuvants, DEX is more widely used.…”

Section: Introductionmentioning

confidence: 99%

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Cai

Fan

Feng³

et al. 2021

BMC Anesthesiol

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Background and Objectives Peripheral injection of dexmedetomidine (DEX) has been widely used in regional anesthesia to prolong the duration of analgesia. However, the optimal perineural dose of DEX is still uncertain. It is important to elucidate this characteristic because DEX may cause dose-dependent complications. The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery. Method A search strategy was created to identify suitable randomized clinical trials (RCTs) in Embase, PubMed and The Cochrane Library from inception date to Jan, 2021. All adult patients undergoing upper limb surgery under BPB were eligible. The RCTs comparing DEX as an adjuvant to local anesthetic (LA) with LA alone for BPB were included. The primary outcome was duration of analgesia for perineural DEX. Secondary outcomes included visual analog scale (VAS) in 12 and 24 h, consumption of analgesics in 24 h, and adverse events. Results Fifty-seven RCTs, including 3332 patients, were identified. The subgroup analyses and regression analyses revealed that perineural DEX dose of 30-50 μg is an appropriate dosage. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of analgesia duration with less than and more than 60 μg doses was 220.31 (153.13–287.48) minutes and 68.01 (36.37–99.66) minutes, respectively. With long-acting LAs, the mean differences (95% CI) with less than and more than 60 μg doses were 332.45 (288.43–376.48) minutes and 284.85 (220.31–349.39) minutes. Conclusion 30-50 μg DEX as adjuvant can provides a longer analgesic time compared to LA alone and it did not increase the risk of bradycardia and hypotension.

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Section: Introductionmentioning

confidence: 99%

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Cai

Fan

Feng³

et al. 2021

BMC Anesthesiol

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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%

“…The selected studies were published between 2014 and 2020, and were carried out in different countries, such as India, China, Iran, Korea, Spain, and Chile. The surgeries that were documented in the studies included limbs surgery (n = 11) [13,14,16,17,[24][25][26][27][28][29][30] and thoracic surgery (n = 2). [15,18] Surgeries in 9 studies [13,15,16,18,[25][26][27][28][29] involved the use of longacting LA, such as ropivacaine, bupivacaine, and levobupivacaine.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The surgeries that were documented in the studies included limbs surgery (n = 11) [13,14,16,17,[24][25][26][27][28][29][30] and thoracic surgery (n = 2). [15,18] Surgeries in 9 studies [13,15,16,18,[25][26][27][28][29] involved the use of longacting LA, such as ropivacaine, bupivacaine, and levobupivacaine. Three trials [17,24,30] reviewed herein used intermediate + long-acting LA, namely lidocaine + bupivacaine.…”

Section: Characteristics Of the Included Studiesmentioning

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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Comparison of ultrasound guided interscalene brachial plexus block using 0.2% ropivacaine with dexmedetomidine and 0.2% ropivacaine with dexamethasone - A prospective observational study

Cited by 2 publications

References 16 publications

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

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

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