Dexmedetomidine Dose Dependently Enhances the Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block

Ouchi, Kentaro; Sugiyama, Katsumi

doi:10.1097/aap.0000000000000380

Cited by 23 publications

(13 citation statements)

References 28 publications

(40 reference statements)

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“…When DEX is combined with a local anesthetic agent for TAP block, it can prolong the duration of block [31] or improve postoperative pain and recovery from anesthesia [32], which is possibly due to local vasoconstriction in peripheral nerves [33] or direct inhibition in peripheral nerve action [34]. DEX was found to dose-dependent enhance of the local anesthetic effect of lidocaine in rats [35] and in healthy volunteers [36].…”

Section: Discussionmentioning

confidence: 99%

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

Qin

Xiang

Li³

et al. 2019

BMC Anesthesiol

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Background Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it. Methods One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 μg/kg), medium (0.50 μg/kg) or high dose (1.0 μg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block (n = 25). The primary outcomes were stress marker levels during the operation. Results One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P < 0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine (P < 0.05). Conclusion The addition of dexmedetomidine at the dose of 0.5 μg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery. Trial registration This study was registered at www.chictr.org.cn on November 6th, 2016 (ChiCTR-IOR-16009753).

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Section: Discussionmentioning

confidence: 99%

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

Qin

Xiang

Li³

et al. 2019

BMC Anesthesiol

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“…This result can be explained by the fact that dexmedetomidine has no antitussive effects, and the passage of a flexible bronchoscope through the vocal cords can lead to coughing (5). Recently, the use of dexmedetomidine as an additive to local anaesthetics was reported to have several advantages over conventional intravenous administration (6,7). Animal experiments have indicated that the local application of dexmedetomidine to the airway can expand the smooth muscle of the trachea and may inhibit the cough response (8).…”

Section: Introductionmentioning

confidence: 99%

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

et al. 2019

J. Thorac. Dis.

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Background: Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method for flexible bronchoscopy. Recently, the use of dexmedetomidine as an additive to local anaesthetics has been reported to have several advantages over conventional intravenous administration. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation. Methods: Sixty patients requiring flexible bronchoscopy were randomly assigned to three groups: (I) nebulized dexmedetomidine + lidocaine, n=20; (II) intravenous dexmedetomidine + nebulized lidocaine, n=20; and (III) nebulized lidocaine alone (no dexmedetomidine), n=20. The patients' coughing scores were assessed and graded. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. The secondary endpoints were the rates of glottis closure, complete jaw relaxation and limb movement during the procedure; the elapsed time until recovery; and the dosages of vasoconstrictors and atropine. Results: The incidence of moderate to severe coughing was 15% in the nebulized dexmedetomidine group, 50% in the intravenous dexmedetomidine group and 55% in the no dexmedetomidine group. The nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019).Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine [P=0.008, odds ratio (OR): 0.273, 95% confidence interval (CI): 0.089-0.833]. No differences in the rates of complete jaw relaxation and limb movement during the procedure were observed among the three groups (all P>0.05). The rates of glottis closure were similar (20%, 25%, and 35%; P>0.05).The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60±1.39 vs. 15.10±1.45, P<0.001). The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001). Conclusions: Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy was well tolerated during bronchoscopies performed under moderate sedation and was associated with a reduced incidence of moderate to severe coughing, a shorter recovery time and reduced vasoconstrictor consumption.

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“…DEX was found to dose-dependent enhance of the local anesthetic effect of lidocaine in rats [28] and in healthy volunteers [29].…”

Section: Discussionmentioning

confidence: 92%

Dexmedetomidine added to ropivacaine for transversus abdominis plane block inhibits stress response in laparoscopic surgery: a randomized controlled trial

Qin

Xiang

et al. 2019

Preprint

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Background: Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it. Methods: One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 µg/kg), medium (0.50 µg/kg) or high dose (1.0 µg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block( n = 25). The primary outcomes were stress marker levels during the operation. Results: One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P < 0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine (P < 0.05). Conclusion: The addition of dexmedetomidine at the dose of 0.5 µg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response in patients undergoing laparoscopic gynecological surgery.

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Dexmedetomidine Dose Dependently Enhances the Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block

Abstract: Dexmedetomidine dose dependently enhances the local anesthetic action of lidocaine in humans. Dexmedetomidine at 2.5 ppm produces similar enhancement of local anesthesia effect as addition of 1:80,000 AD.

Cited by 23 publications

References 28 publications

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

Dexmedetomidine added to ropivacaine for transversus abdominis plane block inhibits stress response in laparoscopic surgery: a randomized controlled trial

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