The Effect of Clonidine Administered with Bupivacaine in Brachial Plexus Block

Yoon, Chang Sub; Choi, Jong Ho; Cho, Sung Kang; Han, Sung Min; Suh, Byung Te

doi:10.4097/kjae.1996.30.5.610

Cited by 2 publications

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“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

Section: Resultsmentioning

confidence: 99%

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The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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Section: Resultsmentioning

confidence: 99%

“…Seven articles were published in languages not covered by the authors team and were translated via neural machine translation software (Google LLC, Mountain View, California, USA): three of these studies [24][25][26] met the inclusion criteria for this systematic review.…”

Section: Literature Searchmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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“…Sedation was reported using 17 different sedation-scales that did not permit meta-analysis of the data. Clonidine was associated with increased sedation in ten trials, [13][14][15]19,22,27,29,30,42,44 whereas twelve trials found no difference in sedation between Note: GRADE Working Group grades of evidence-High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.…”

Section: Sedationmentioning

confidence: 99%

Alpha₂‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses

Andersen

Karlsen

Geisler

et al. 2021

Acta Anaesthesiol Scand

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Background:We review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for brachial plexus blocks (BPB). Methods:We included randomised controlled trials on upper limb surgery with BPBs in adults, comparing dexmedetomidine with clonidine or either drug with placebo.The primary outcome was duration of analgesia. Secondary outcomes included adverse and serious adverse events. The review was conducted using Cochrane standards, trial sequential analyses (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We included 101 trials with 6248 patients. Overall, duration of analgesia was prolonged with both clonidine (176 min [TSA adj. 95% CI: 118, 205, p < .00001; 33 trials]) and dexmedetomidine (292 min [TSA adj. 95% CI: 245 329, p < .00001; 53 trials]), but was longer for dexmedetomidine than clonidine (205 min [TSA adj. 95% CI: 157, 254, p < .00001; 19 trials]). Compared with placebo, dexmedetomidine was associated with bradycardia (RR 4.2 [95% CI 2.2, 8.3]), and both clonidine (RR 4.5 [95% CI 1.1, 18.3]) and dexmedetomidine (RR 3.9 [95% CI 2.0, 7.5]) were associated with hypotension. Serious adverse events were mostly related to block technique. GRADErated quality of evidence was low or very low. Conclusion:Alpha2-receptor agonists used as adjuvants for BPBs lead to a prolonged duration of analgesia, with dexmedetomidine as the most efficient. Alpha2-receptor agonists were associated with increased risk of cardiovascular adverse events. The quality of evidence was low to very low.

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The Effect of Clonidine Administered with Bupivacaine in Brachial Plexus Block

Cited by 2 publications

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The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Alpha₂‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses

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The Effect of Clonidine Administered with Bupivacaine in Brachial Plexus Block

Cited by 2 publications

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The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Alpha2‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses

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Alpha₂‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses