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

Cai, Hai; Fan, Xing; Feng, Peng-Jiu; Wang, Xiaogang; Xie, Yubo

doi:10.1186/s12871-021-01452-0

Cited by 7 publications

(8 citation statements)

References 77 publications

(98 reference statements)

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“…Unfortunately, a study evaluating a perineural dose of 100 μg reported a case of minor nerve damage that persisted for 5 months and a frequent occurrence of episodes of bradycardia and mild to moderate sedation [12]. Previously, a meta-analysis in the setting of brachial plexus block has investigated the clinical effects of perineural dexmedetomidine and suggests an optimal dose of 50-60 μg for the balance [13]. However, subsequent meta-analyses [2, 14,15], failed to demonstrate a doserelated difference for the clinical effects of perineural dexmedetomidine, partially due to a lack of evidence.…”

Section: Introductionmentioning

confidence: 99%

Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

Liu

Guo²,

Zheng³

et al. 2022

BMC Anesthesiol

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Purpose Dexmedetomidine has been proposed as an additive to local anesthetics to prolong peripheral nerve block duration; however, perineural dexmedetomidine has been associated with an increased risk of bradycardia and hypotension This randomized controlled study investigated the effects of low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia. Methods Fifty-five patients who had undergone elective upper extremity surgery were randomized to receive an ultrasound-guided supraclavicular brachial plexus block with 20 mL 0.5% ropivacaine with or without 30 μg dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included the onset time and duration of the motor and sensory blocks, incidence of hypotension and bradycardia, total postoperative analgesics, and safety assessment during the 24 h after surgery. Results Dexmedetomidine significantly prolonged the duration of analgesia (887 ± 92 min vs 661 ± 83 min, P < 0.0001). The onset time and the duration of motor and sensory block were significantly different between the groups (all P < 0.001). No episodes of hypotension or bradycardia were detected in the dexmedetomidine group. The total postoperative analgesic use and side effect profiles in the first 24 h postoperative period were similar for both groups. Conclusions Low-dose dexmedetomidine (30 μg) as a perineural adjuvant significantly prolonged the analgesic duration of a brachial plexus block without inducing hemodynamic instability. Trial registration This trial was registered at ClinicalTrial.gov (NCT02630290).

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Section: Introductionmentioning

confidence: 99%

Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

Liu

Guo²,

Zheng³

et al. 2022

BMC Anesthesiol

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“…In addition, the optimal dose of DEX for analgesia will differ by objects, surgeries, methods of administration, etc. [44][45][46]. Our novel finding showed that intraperitoneal injection of DEX with 6.25 µg/kg has reached the peak of analgesic effect in adult mice.…”

Section: Discussionmentioning

confidence: 92%

A New Potential Antidepressant: Dexmedetomidine Alleviates Neuropathic Pain-Induced Depression by Increasing Neurogenesis in the Hippocampus

Zhao²,

He³

et al. 2022

Pharmacology

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Introduction: Studies have suggested dexmedetomidine (DEX) as a potential antidepressant. However, no relevant research exists on its effects and mechanisms in curing depression caused by chronic pain. Therefore, an understanding of DEX’s role in depressive disorders proposes new approaches for antidepressant treatment. Methods: In this study, C57Bl/6 mice (n = 80) were divided into sham (n = 8) and chronic constrictive injury (CCI, n = 72) groups. The CCI group was further divided into six subgroups: CCI + normal saline (NS), CCI + DEX6.25, CCI + DEX12.5, CCI + DEX25, CCI + DEX50, and CCI + DEX100. Fourteen days after CCI, mice that did not develop a depressive phenotype were excluded through sucrose preference test (SPT), forced swimming test (FST), paw thermal withdrawal latency (PTWL), and serum corticosterone (CORT). Subsequently, mice in the sham group were administered 0.1 mL/10 g NS once daily. However, mice in the CCI subgroups were administered NS (0.1 mL/10 g), DEX (6.25 µg/kg), DEX (12.5 µg/kg), DEX (25 µg/kg), DEX (50 µg/kg), and DEX (100 µg/kg) intraperitoneally once daily for 1 week, respectively. Afterward, bromodeoxyuridine (BrdU) was injected intraperitoneally once daily as well for 3 consecutive days before sampling, following BrdU- and doublecortex (DCX)-positive cell detection in the hippocampus through immunofluorescence. Results: The success rate of the chronic pain-depression (CPD) model was 62.5%. As observed, DEX dose-dependently affected sucrose preferences during the SPT and immobility time during FST. Results also showed that 25 µg/kg DEX had the best promotion effect during increased sucrose preference and reduced immobility time. Moreover, although DEX improved PTWL and serum CORT, no improvement over the DEX 25 µg/kg treatment was observed. Compared to the sham group, the percentage of BrdU+ and DCX+ cells was also significantly lower in the CCI + NS group. Besides, DEX dose-dependently affected cell proliferation and neuronal differentiation. Additionally, the percentage of BrdU+ and DCX+ cells in the dentate gyrus (DG) region of the hippocampus was highest in the CCI + DEX25 group. Conclusion: Therefore, DEX dose-dependently alleviates depression induced by chronic pain through neurogenesis promotion in the DG region of the hippocampus.

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“…These alterations are greatly affected by the route of administration, dose of the drug and the rate of drug delivery. In a recent meta-analysis, it was concluded that perineural doses ranging from 2 -50 µg and intra venous doses upto 3 µgm/kg does not influence hemodynamic response [7]. The results imply that, haemodynamic stability is an complemented advantage of dex.…”

Section: Discussionmentioning

confidence: 97%

Comparative Evaluation of 0.5% Levobupivacaine V/S 0.5% Levobupivacaine Mixed with 20µG Dexmedetomidine in Mandibular Iii Molar Surgeries – A Double Blind Randomised Controlled Trial

Patil

Bhola

2022

JPRI

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Background: Mandibular third molars (M3M) are the most common impacted teeth in the human dentition. Removal or extraction of these teeth is frightening for the patients owing to the perception of pain. As a result, pain control mechanism like anesthesia is the major factor that needs to be executed appropriately. Using newer local anesthetic drugs minimizes side effects and drug interactions. Levobupivacaine (Levo) is a congener of bupivacaine thereby minimizing the cardiotoxic effects of bupivacaine. Dexmedetomidine (Dex) is an alpha agonist which alongwith Levo is capable of providing prolonged duration of anesthesia decreasing the need for rescue analgesics. Aim: This study will compare the anesthetic effectiveness between Levo and Levo alongwith Dex during the extraction of impacted M3M. Methodology: A total of 50 consecutive systemically healthy patients requiring unilateral surgical extraction of impacted M3M with similar orientations will be divided into two groups randomly, one group (L) will receive nerve block with levo while the second group (LD) will receive Levo plus Dex during the extraction procedure. Results: ‘Students t-test’ will be used to analyse and evaluate. The patients will be evaluated based on different parameters. The patient will be asked to reciprocate about the first bout of pain experience based on the Visual Analog Scale that will be handed over to patient after the procedure. The other parameters that will be evaluated are Onset on Anesthesia, Depth of Anesthesia, Hemodynamics, Oxygen saturation level, Sedation level and duration of post-operative analgesia. The patient will be evaluated over the time duration after which the patient had to take a rescue analgesic. Conclusion: Levo with Dex is more efficient than Levo in providing prolonged duration of anesthesia and has prolonged duration of postoperative analgesia.

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

Cited by 7 publications

References 77 publications

Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

A New Potential Antidepressant: Dexmedetomidine Alleviates Neuropathic Pain-Induced Depression by Increasing Neurogenesis in the Hippocampus

Comparative Evaluation of 0.5% Levobupivacaine V/S 0.5% Levobupivacaine Mixed with 20µG Dexmedetomidine in Mandibular Iii Molar Surgeries – A Double Blind Randomised Controlled Trial

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