To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: A double-blind, prospective, randomized study

Farooq, Nyla; Singh, Raj; Sarkar, Arindam; Rasheed, Mohd Asim; Choubey, Sanjay

doi:10.4103/aer.aer_30_17

Cited by 20 publications

(11 citation statements)

References 21 publications

(27 reference statements)

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“…This may be due to the use of ropivacaine rather than bupivacaine as ropivacaine has a longer duration of action, and the effect of adjuvants may not appear. [ 15 ] Furthermore, our results shows that there is statistically difference between fentanyl group, dexmedetomidine group, and bupivacaine group as regards to intraoperative HR with low HR among fentanyl group which can be explained by association of fentanyl with a vagus nerve-mediated bradycardia. This differs from Manohar and Prakash that shows lower HRs with dexmedetomidine group than fentanyl, and this difference may be due to larger number of patients in their study with use of smaller doses of fentanyl (50 mg only).…”

Section: Discussionmentioning

confidence: 74%

Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: A randomized controlled study

2018

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Background:Brachial plexus block is gaining popularity day by day for upper limb surgery. The supraclavicular brachial plexus block may be used for surgical anesthesia alone or in conjunction with general anesthesia.Aims:We intended to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine on onset and duration of block and postoperative analgesia during ultrasonic guided supraclavicular nerve block for upper limb surgeries.Settings and Design:This study design was a prospective randomized controlled double-blinded clinical study.Patients and Methods:Sixty patients with American Society of Anesthesiologists physical status Classes I and II, aged 18–50 years, scheduled for upper limb surgery were randomly divided into three study groups each group contains 20 patients: C Group: receive 0.5 mL/kg up to a maximum of 40 mL volume. The dose of bupivacaine was 1.5 mg/kg. D Group: Bupivacaine as control group + 1 mg/kg dexmedetomidine. F Group: Bupivacaine as control group + 1 mg/kg fentanyl. Patients were observed for onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects.Statistical Analysis Used:One-way ANOVA test and Chi-square test were used.Results:The onset time of sensory and motor blockade was shortened. and the duration of the block was significantly prolonged in the D Group (P < 0.001) and F Group (P < 0.001). The duration of postoperative analgesia was also longer in the D Group 13.5 h compared with the F Group 8.3 h and C Group 7.5 h. Hypotension and bradycardia were recorded in 2 patients in D Group, and nausea and vomiting were recorded in F Group.Conclusions:Addition of dexmedetomidine was better in prolongation of the duration of supraclavicular brachial plexus block and improvement of postoperative analgesia than fentanyl and bupivacaine alone without significant adverse effects in patients undergoing upper limb surgeries.

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Section: Discussionmentioning

confidence: 74%

Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: A randomized controlled study

2018

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“…3 ). And adding dexmedetomidine to ropivacaine obviously decreased the time to sensory block onset both in groups with dosage greater [ 12 , 14 , 16 – 21 , 23 ] (MD, −2.97 minutes, 95% CI −4.94 to −1.01 minutes, I 2 = 86%; P = .003) and less [ 13 , 15 , 22 ] (MD, −6.96 minutes, 95% CI −11.85 to −2.06 minutes, I 2 = 86%; P = .005) than 50 μg (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

Dai

Tang

2018

Medicine

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Background:Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB).Methods:A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers.Results:Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], −3.86 minutes, 95% CI −5.45 to −2.27 minutes; I2 = 85%) and motor (MD, −5.21 minutes; 95% CI −7.48 to −2.94 minutes; I2 = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87–269.52 minutes; I2 = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48–230.91 minutes; I2 = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes; I2 = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI −0.02 to 0.05, I2 = 45%; P = .45) and hypotension (RD, 0.01, 95% CI −0.01 to 0.03, I2 = 0%; P = .57) between 2 groups.Conclusion:Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.

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“…Dexmedetomidine and fentanyl have been used as adjuvant to local anesthetics in different surgeries to provide superior analgesia and to improve the duration of the block [ 9 – 11 ]. One study on lower limbs surgery showed a better efficacy with dexmedetomidine [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

et al. 2018

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BackgroundSpinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs.MethodsIn this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups. Via intrathecal approach, the patients received 2.5 ml hyperbaric bupivacaine 0.5% plus 5 micrograms dexmedetomidine (BD group), 25 micrograms fentanyl (BF group) or 0.5 ml normal saline (BN group), respectively. Time to reach the complete motor block, the highest sensory level, regression from block, analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups.ResultsThere was no significant difference between the groups regrading time to reach complete motor block, but time to reach the highest sensory level was shorter in group BD than group BF (6.28 ± 1.75 vs. 7.17 ± 1.45, p = 0.03). Group BD had significantly lower mean of NRS 6 h after operation (1.90 ± 0.84 vs. 6.16 ± 1.44 vs. 6.30 ± 1.17, p < 0.001) and longer duration to regress to Bromage 0 (331.60 ± 73.96 vs. 185.56 ± 35.87 vs. 147.03 ± 33.05 min, p < 0.001), to analgesic request (496.63 ± 70.19 vs. 296.33 ± 44.83 vs. 221.83 ± 22.26 min, p < 0.001), to regress two sensory levels (149.00 ± 23.17 vs. 88.90 ± 12.85 vs. 69.33 ± 6.67 min, p < 0.001) and to regress to S1 (560.53 ± 81.86 vs. 329.83 ± 44.10 vs. 241.83 ± 22.26 min, p < 0.001). Serial changes in SBP (p = 0.006), DBP (p = 0.03) and HR (p = 0.002) in group BF were significantly higher than the other two groups. The three groups had comparable side effects.ConclusionsUsing dexmedetomidine as an adjuvant to bupivacaine for spinal anesthesia in lower limb surgeries has longer duration of sensory and motor block and longer postoperative analgesia.Trial registrationIRCT registration number: IRCT2017041010599N15, 24 May 2017.

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To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: A double-blind, prospective, randomized study

Cited by 20 publications

References 21 publications

Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: A randomized controlled study

Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: A randomized controlled study

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

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