What is known and objective: The aim of this study was to elucidate the effect of dexmedetomidine added to ropivacaine on the onset and duration of sensory and motor block and duration of analgesia of ultrasound-guided axillary brachial plexus block.Methods: Thirty-seven ASA physical status I-II patients with elective forearm and hand surgery under ultrasound-guided axillary brachial plexus block were randomly divided into 2 groups. Patients in ropivacaine-dexmedetomidine group (group RD, n = 19) received 15 mL of 0.5% ropivacaine with 100 μg (1 mL) dexmedetomidine, and patients in ropivacaine group (group R, n = 18) received 15 mL of 0.5% ropivacaine with 1 mL of normal saline. Onset time and duration of sensory and motor block and duration of analgesia were assessed.Results and discussion: Duration of sensory block (U-value = 35, P < .001), duration of motor block (P = .001) and duration of analgesia (P < .001) were extended in group RD compared to group R. Onset time of sensory block in group RD was significantly faster than in group R (U-value = 65.5, P = .001). Onset time of motor block showed no significant difference between the 2 groups (U-value = 116.5, P = .096). Adverse reactions were reported only in group RD (bradycardia in 2 and hypotension in 3 patients). What is new and conclusion:Our study indicated that dexmedetomidine 100 μg as adjuvant on ultrasound-guided axillary plexus block significantly prolonged the duration of sensory block and analgesia, as well as accelerated the time to onset of sensory block. These results should be weighed against the increased risks of motor block prolongation, transient bradycardia and hypotension and allow for attentive optimism, only if prolonged clinical trials provide a definitive answer. K E Y W O R D S axillary brachial plexus block, dexmedetomidine, ropivacaine | WHAT IS KNOWN AND OBJECTIVEThe axillary brachial plexus block is widely used for orthopaedic surgery of the upper extremity as an alternative to general anaesthesia.It is relatively simple to perform and with the advent of ultrasound technology, and there is a marked improvement in success rate of anaesthesia. 1Regional anaesthesia with long-acting local anaesthetics (LAs), such as ropivacaine, is beneficial for effective postoperative pain control, but the duration of sensory block is still not sufficient to avoid | 349 KORAKI et Al.the postoperative use of opioids. Perineural catheters and continuous infusion are an effective alternative to prolong the analgesic effects, 2 but they can present challenges related to patient management, catheter displacement and the potential for increased infection risk. 3 On the other hand, the use of adjuvants, such as adrenaline, clonidine, opioid and steroids, with local anaesthetics for early onset and for prolonging the duration of blocks has been practiced for many years and remains the subject of much interest. 4Dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist that has an alpha-2 to alpha-1 selectivity ratio 7 times greater than tha...

Two-point bilateral BSCPB has a major analgesic effect on patients after total thyroidectomy, with a statistically significant reduction in postoperative pain scores. However, no significant difference was noted in the proportion of patients that required additional analgesics.

We believe that commissioners of healthcare should question whether the benefits of laparoscopic cholecystectomy justify the additional cost after the introduction of the mini-laparotomy approach.

BackgroundAdequate cerebral perfusion pressure with quick and smooth emergence from anesthesia is a major concern of the neuroanesthesiologist. Anesthesia techniques that minimize anesthetic requirements and their effects may be beneficial. Esmolol, a short acting hyperselective β-adrenergic blocker is effective in blunting adrenergic response to several perioperative stimuli and so it might interfere in the effect of the anesthetic drugs on the brain. This study was designed to investigate the effect of esmolol on the consumption of propofol and sevoflurane in patients undergoing craniotomy.MethodForty-two patients that underwent craniotomy for aneurysm clipping or tumour dissection were randomly divided in two groups (four subgroups). Anesthesia was induced with propofol, fentanyl and a single dose of cis-atracurium, followed by continuous infusion of remifentanil and either propofol or sevoflurane. Patients in the esmolol group received 500 mcg/kg of esmolol bolus 10 min before induction of anesthesia, followed by additional 200 mcg/kg/min of esmolol. Monitoring of the depth of anesthesia was also performed using the Bispectral Index-BIS and cardiac output. The inspired concentration of sevoflurane and the infusion rate of propofol were adjusted in order to maintain a BIS value between 40–50. Intraoperative emergence was detected by the elevation of BIS value, HR or MAP.ResultsThe initial and the intraoperative doses of propofol and sevoflurane were 18–50 mcg/kg/min and 0.2–0.5 MAC respectively in the esmolol group, whereas in the control group they where 100–150 mcg/kg/ and 0.9–2.0 MAC respectively (p = 0.000 for both groups). All procedures were anesthesiologically uneventful with no episodes of intraoperative emerge.ConclusionsEsmolol is effective not only in attenuating intraoperative hemodynamic changes related to sympathetic overdrive but also in minimizing significant propofol and sevoflurane requirements without compromising the hemodynamic status.ClinicalTrials.gov Identifier: NCT02455440. Registered 26 May 2015.