Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine

Elmaddawy, Alaa Eldin Adel; Mazy, Alaa

doi:10.4103/sja.sja_653_17

Cited by 12 publications

(6 citation statements)

References 37 publications

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“…In agreement with the current study, Elmaddawy et al [ 24 ] and Kannan et al [ 25 ] found that the time to first request for pethidine in ultrasound-guided superficial cervical plexus block receiving plain bupivacaine was approximately 7 h postoperative in patients undergoing thyroid surgery. However, Kendall et al [ 26 ] in their meta-analysis reported that patients undergoing orthopedic or spine surgeries experienced pain relief for up to 12 h postoperative when comparing erector spinae block with a control group.…”

Section: Discussionsupporting

confidence: 92%

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial

Kamel,

Fahmy,

Fathi

et al. 2024

BMC Anesthesiol

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Background Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery. Methods In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia. Results The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg). Conclusions For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group. Trial registration The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13–10-2022).

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Section: Discussionsupporting

confidence: 92%

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial

Kamel,

Fahmy,

Fathi

et al. 2024

BMC Anesthesiol

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“…The patient remained sedated and could be awakened at any time during the operation, but the mean arterial pressure and heart rate decreased after the procedure, requiring the anesthesiologist to pay close attention to hemodynamic changes during the operation. Elmaddawy et al 96 mixed bupivacaine, epinephrine, and dexmedetomidine in thyroid surgery for bilateral CPB. The results demonstrated that applying 1 µg/kg dexmedetomidine around the cervical plexus prolonged the analgesic time during and after surgery, reduced the demand for opioids, and reduced the heart rate.…”

Section: Application Of Dexmedetomidine In Peripheral Nerve Blockmentioning

confidence: 99%

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Chen¹,

Liu²,

Feng³

et al. 2023

DDDT

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Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. It is the key to enhance clinical rehabilitation as an important part of the multimodal analgesia scheme. The emergence of ultrasound technology has accelerated peripheral nerve block technology development. It can directly observe the nerve shape, surrounding tissue, and diffusion path of drugs. It can also reduce the dosage of local anesthetics by improving positioning accuracy while enhancing the block’s efficacy. Dexmedetomidine is a highly selective drug α 2 -adrenergic receptor agonist. Dexmedetomidine has the characteristics of sedation, analgesia, anti-anxiety, inhibition of sympathetic activity, mild respiratory inhibition, and stable hemodynamics. Numerous studies have revealed that dexmedetomidine in peripheral nerve blocks can shorten the onset time of anesthesia and prolong the time of sensory and motor nerve blocks. Although dexmedetomidine was approved by the European Drug Administration for sedation and analgesia in 2017, it has not yet been approved by the US Food and Drug Administration (FDA). It is used as a non-label drug as an adjuvant. Therefore, the risk-benefit ratio must be evaluated when using these drugs as adjuvants. This review explains the pharmacology and mechanism of dexmedetomidine, the effect of dexmedetomidine on various peripheral nerve block as an adjuvant, and compare it with other types of adjuvants. We summarized and reviewed the application progress of dexmedetomidine as an adjuvant in nerve block and look forward to its future research direction.

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“…The involvement of the noradrenergic system in the perception of pain is known since studies show that noradrenergic neurons in the locus ceruleus mediate analgesia via axon terminals in the spinal dorsal cord , besides several agonist drugs of the alpha noradrenergic receptor show analgesic effect, such as dexmedetomidine and clonidine . No influence of yohimbine on the effect of the compounds was observed, evidencing the absence of noradrenergic participation in the activity of the compounds.…”

Section: Discussionmentioning

confidence: 63%

Pharmacological evaluation underlying the antinociceptive activity of two new hybrids NSAIDs tetrahydropyran derivatives

Oliveira

Capim

Gonçalves

et al. 2019

Fundamemntal Clinical Pharma

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The development of analgesic drugs is still a necessity due to the inefficiency of the current treatments for some pathological conditions and also due to the adverse effects produced by these drugs. The aim of this study was to deepen the pharmacological study of two new hybrids NSAIDs tetrahydropyran derivatives, regarding their antinociceptive effects on acute pain in mice. Male swiss mice were evaluated in the acetic acid-induced abdominal writhing, formalin, tail-flick, open-field, glutamate-and capsaicin-induced paw licking tests, and in vitro Cox inhibition assay, besides the acute toxicological evaluation. The compounds had an effect on the acetic acid-induced abdominal writhing, formalin (both phases), and tail-flick tests. In the study of the mechanism of action was observed reversion of the antinociceptive effect of the compounds from the previous administration of naloxone, L-NAME (L-nitro-arginine methyl ester), ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one), glibenclamide, and nor-binaltorphimine, by the intrathecal and intraperitoneal routes. The prior administration of MK-801 suggests that the modulation of NMDA receptor contributes to the antinociceptive effect of compounds. In summary, hybrid compounds presented central antinociceptive effect, demonstrating participation of the NO-cGMP-K + ATP pathway, j-opioid, and NMDA receptors. In addition, the compounds showed inhibition of cyclo-oxygenase enzymes and adverse effects were not observed with dose 300 times greater than the dose used experimentally.

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Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine

Cited by 12 publications

References 37 publications

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Pharmacological evaluation underlying the antinociceptive activity of two new hybrids NSAIDs tetrahydropyran derivatives

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