Background The present study was designed to test the hypothesis that dexmedetomidine added to ropivacaine would increase the duration of antinociception to a thermal stimulus in a dose-dependent fashion in a rat model of sciatic nerve blockade. Methods Fifty adult Sprague Dawley rats (10 rats/group) received unilateral sciatic nerve blocks with 0.2 ml of 0.5% ropivacaine or 0.2 ml of 0.5% ropivacaine plus dexmedetomidine (2.7 μM [0.5 μg/kg], 11.7 μM [2 μg/kg], 34.1 μM [6 μg/kg], or 120.6 μM [20 μg/kg]) in a randomized, blinded fashion. Time to paw withdrawal latency to a thermal stimulus for both paws and an assessment of motor function were measured every 30 min after the nerve block until a return to baseline. Results Dexmedetomidine added to ropivacaine increased the duration of dense sensory blockade and time for return to normal sensory function in a dose-dependent fashion (p < 0.005). There was a significant time (p < 0.005), dose (p < 0.005), and time by dose effect (p < 0.005) on paw withdrawal latencies of the operative paws. There were no significant differences in paw withdrawal latencies of the control paws, indicating little systemic effect of the dexmedetomidine. The duration of motor blockade was also increased with dexmedetomidine. High-dose dexmedetomidine (120.6 μM) was not neurotoxic. Conclusion This is the first study showing that dexmedetomidine added to ropivacaine increases the duration of sensory blockade in a dose-dependent fashion in rat. The findings are an essential first step encouraging future efficacy studies in humans.

Sensory analgesia provided by dexmedetomidine added to ropivacaine for peripheral nerve blocks in rat is a peripherally mediated effect.

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BackgroundImmune check point inhibitors (ICIs) have emerged as a new therapeutic paradigm for a variety of malignancies including metastatic melanoma. As the use of ICIs expand, immune-mediated adverse events are becoming a common occurrence.Case presentationWe describe the first reported patient with small vessel vasculitis, manifested by digital ischemia, following treatment with high dose Ipilimumab for resected stage IIIB/C melanoma. This patient received high dose steroids, five-day intravenous (IV) Epoprostenol protocol, botulinum toxin injections, and Rituximab 375 mg/m2 weekly for four cycles. With this treatment regimen, the digital ischemia did not progress proximally, but she did require multiple distal digit amputations about six months after the onset of her symptoms.ConclusionsPrompt identification and management of immune related adverse events (IRAEs) are critical to optimal patient management. This patient’s vasculitis did not reverse, but was likely halted and stabilized with multiple immunosuppressive medications.

Objective Medication access and adherence are important determinants of health outcomes. We investigated factors associated with access and cost‐related nonadherence to prescriptions in a population‐based cohort of systemic lupus erythematosus (SLE) patients and controls. Methods Detailed sociodemographic and prescription data were collected by structured interview in 2014–2015 from participants in the Michigan Lupus Epidemiology and Surveillance (MILES) cohort. We compared access between cases and frequency‐matched controls and examined associated factors in separate multivariable logistic regression models. Results A total of 654 participants (462 SLE patients, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) were Black, and the mean age was 53 years. SLE patients and controls reported similar frequencies of being unable to access prescribed medications (12.1% versus 9.4%, respectively; P was not significant). SLE patients were twice as likely as controls to report cost‐related prescription nonadherence in the preceding 12 months to save money (21.7% versus 10.4%; P = 0.001) but were also more likely to ask their doctor for lower cost alternatives (23.8% versus 15.6%; P = 0.02). Disparities were found in association with income, race, and health insurance status, but the main findings persisted after adjusting for these and other variables in multivariable models. Conclusion SLE patients were more likely than controls from the general population to report cost‐related prescription nonadherence, including skipping doses, taking less medicine, and delaying filling prescriptions; yet, <1 in 4 patients asked providers for lower cost medications. Consideration of medication costs in patient decision‐making could provide a meaningful avenue for improving access and adherence to medications.