Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

Pan, Liping; Wu, Hao; Liu, Heng; Yang, Xin; Meng, Zhichao; Cao, Yongping

doi:10.21203/rs.3.rs-34365/v2

Cited by 4 publications

(6 citation statements)

References 13 publications

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“…32 A meta-analysis also revealed that it is effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioid consumption, prolong analgesic duration, and increase patient satisfaction without increasing related complications. 33 Our results were similar with that showed in the above two studies. All of these results indicated that dexmedetomidine added local anesthetics decreased the opioid consumption and provide a better postoperative analgesia.…”

Section: Discussionsupporting

confidence: 93%

Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patient undergoing arthroscopic shoulder surgery: A randomized controlled clinical trial

Luan

Hao

et al. 2022

Preprint

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Background Dexmedetomidine, a potent and highly selective α2-adrenoreceptor agonist has become a popular adjuvant to local anesthetics. The study was designed to explore the effect of dexmedetomidine added to ropivacaine for interscalene brachial plexus block (IBPB) on postoperative analgesia in patient undergoing arthroscopic shoulder surgery. Methods Forty four adult patients undergoing arthroscopic shoulder surgery were randomly divided into 2 groups. Group R received 0.25% ropivacaine alone, whereas group RD received 0.25% ropivacaine and 0.5 µg/kg dexmedetomidine. A total volume of 15 ml was administered in ultrasound-guided IBPB in both groups. Duration of analgesia, Visual analogue scale (VAS) pain score, frequency of PCA pressed, first time of PCA pressed, sufentanil consumption, and patient satisfaction with analgesia quality were recorded. Results Compared with group R, duration of analgesia was prolonged (8.25±1.76 vs. 11.55±2.41 h; P < 0.05), VAS pain scores was decreased at 8 and 10 h postoperatively (3(2–3) vs. 0(0–0) and 2(2–3) vs. 0(0-2.25), respectively; P < 0.05), the frequency of PCA pressed was decreased at 4–8 and 8–12 h time intervals (0(0-0.25) vs. 0(0–0) and 5(1.75-6) vs. 0(0–2), respectively; P < 0.05), the time of first PCA pressed was prolonged (9.27±1.85 vs. 12.98±2.35 h; P < 0.05), the total 24h sufentanil consumption was reduced (108.72±15.92 vs. 94.65±12.47 µg; P < 0.05 ) and patient satisfaction score was also improved (3(3–4) vs. 4(4–5); P < 0.05) in group RD. Conclusion We conclude that adding 0.5 µg/kg dexmedetomidine to 0.25% ropivacaine for IBPB provided better postoperative analgesia, decreased the sufentanil consumption and improved the patient’s satisfaction in patients undergoing arthroscopic shoulder surgery.

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Section: Discussionsupporting

confidence: 93%

Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patient undergoing arthroscopic shoulder surgery: A randomized controlled clinical trial

Luan

Hao

et al. 2022

Preprint

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“…Ultrasound-guided continuous femoral nerve block for postoperative analgesia is widely used in clinical practice. However, due to incomplete obturator nerve block and incomplete puncture in the ultrasound image, it is difficult to control the depth of the needle insertion and often difficult to achieve a satisfactory analgesic effect [4,5]. e "Shamrock method" is a new ultrasonic-guided lumbar plexus nerve block method with in-plane needle insertion, in which a low-frequency probe is placed at the head side of the iliac crest of a patient to obtain ultrasound cross-sectional images of the lumbar spine and paravertebral structure, including ultrasound images of the lumbar plexus nerve.…”

Section: Introductionmentioning

confidence: 99%

Continuous Lumbar Plexus Block under the Guidance of the “Shamrock Method” Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients

Xue

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the effect of continuous lumbar plexus block guided by the “Shamrock method” on postoperative analgesia and hemodynamics in elderly patients after total knee arthroplasty (TKA). Methods. From January 2020 to December 2020 in our hospital, 98 patients who underwent TKA were selected. Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group (group L), with 49 patients, and a continuous femoral nerve block group (group F), with 49 patients. The onset time and maintenance time of motor and sensory nerve blocks in patients were recorded. A visual analogue scale (VAS) was applied to assess the pain severity at 6, 12, 24, and 48 h after the operation. The VAS score (FVAS) was applied to evaluate the pain severity of the patients during 24 and 48 h after the operation and knee joint functional exercise. The levels of hemodynamic indexes such as heart rate, mean arterial pressure, and oxyhemoglobin saturation and the levels of hemorheological indexes such as plasma viscosity, high and low whole blood shear viscosity, fibrinogen, and hematocrit were detected and compared between the two groups immediately after the operation and at 12 h and 48 h after the operation, respectively. The incidence of adverse reactions induced by anesthesia was counted. Results. The onset time of motor and sensory nerve blocks in group L was lower than that in group F, and the maintenance time was higher than that in group F ( P < 0.05 ). The VAS scores of 6, 12, 24, and 48 h after operation in group L were significantly lower than those in group F ( P < 0.05 ). The FVAS scores of group L at 24 and 48 h after operation were significantly lower than those of group F ( P < 0.05 ). The heart rates of the patients in the two groups were higher at 12 h and 48 h after operation than those immediately after operation ( P < 0.05 ). The heart rates at 12 h and 48 h after operation in group L were lower than those in group F ( P < 0.05 ). The plasma viscosity, high whole blood shear viscosity, and low whole blood shear viscosity in the group L at 12 h and 48 h after operation were lower than those in group F ( P < 0.05 ). There was no significant difference in the incidence of local anesthetic poisoning, nausea, vomiting, urinary retention, pruritus, and other adverse reactions between the two groups ( P > 0.05 ). Conclusion. The “Shamrock method” ultrasound-guided continuous lumbar plexus block in elderly patients after TKA has good analgesic effect, stable hemodynamics, little influence on hemorheology, and good safety. It is of great value to enhance the surgical effect and promote postoperative rehabilitation.

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“…Pan L et al also concluded that pain scores significantly decreased at different time points postoperatively when dexmedetomidine was used an adjunct to nerve blocks. 18 Motor strength was important factor to keep track of for the patients as well as for the surgeons because early rehabilitation is essential and helpful for the success of TKR. Dexmedetomidine combined with local anesthetics in nerve block could increase motor strength compared to local anesthetics alone.…”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine combined with local anesthetics in nerve block could increase motor strength compared to local anesthetics alone. 18 This is likely due to the fact that dexmedetomidine can inhibit the local anesthetics to penetrate the motor fibre. Motor strength on both sides in group C is significantly higher than group A.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of postoperative analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound guided adductor canal block in patients undergoing unilateral Total Knee Replacement

Kumar¹,

Chattopadhyay

Parashar³

et al. 2022

IJCA

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The aim of anaesthesia in Total knee replacement (TKR) is to provide adequate analgesia and early ambulation. The recent success of adductor canal block in providing post-operative analgesia and achieving early ambulation has evoked interest in studying the effects of local anaesthetic agents and various adjuvants.This study was a randomized three arm parallel group comparative study conducted in a tertiary care center in India on 135 patients undergoing unilateral total knee replacement under spinal anaesthesia. After completion of the surgery, the adductor canal block was performed with ultrasound guidance at mid-thigh level in all three groups. In group A, 20 ml 0.375% ropivacaine was only used but in group B and C Dexmedetomidine was added to ropivacaine (total volume of 20 ml; 0.375%) at a dose of 0.25 µg/kg and 0.50 µg/kg respectively. The primary outcome of the study was to compare duration of analgesia after the adductor canal block. Duration to rescue analgesia (in hours) was significantly longer [Group A: 15.71±4.87; Group B: 16.44±6.21; Group C: 19.78±5.57 (p=0.014)] and total opioid (24 hours tramadol needed in mg) consumption [Group A: 60.00±13.94; Group B: 52.22±18.80; Group C: 33.33±13.95 (p=0.033)] was significantly lower in Group C. NRS scores both at movement and rest were significantly lesser in Group C at 18 and 24 hours timepoints. Patient satisfaction was significantly higher in Group C with 46.67% patient reporting better than expected peri-operative experience (p=0.022).The addition of dexmedetomidine, 0.5 µg/kg to 0.375% ropivacaine in adductor canal block results in longer duration of analgesia, less 24 hours opioid consumption, better motor strength and better patient satisfaction without any adverse effect after unilateral total knee replacement surgery.

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Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

Cited by 4 publications

References 13 publications

Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patient undergoing arthroscopic shoulder surgery: A randomized controlled clinical trial

Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patient undergoing arthroscopic shoulder surgery: A randomized controlled clinical trial

Continuous Lumbar Plexus Block under the Guidance of the “Shamrock Method” Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients

Evaluation of postoperative analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound guided adductor canal block in patients undergoing unilateral Total Knee Replacement

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