“Above All, Do No Harm”

Gerner, Peter

doi:10.1097/aln.0b013e3181bbcd2c

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Current perineural applications for dexmedetomidine rely on off‐label uses of the drug. Although experimental studies did not find neurotoxicity associated with perineural dexmedetomidine injection, caution remains before widespread clinical use …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block

et al. 2017

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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...

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block

et al. 2017

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“…Even if the incidence of severe side effects is rare, it is very important that we approach this technique with full knowledge of the risks in order to improve the outcome of patients (Allegri et al, 2008; Gerner, 2009).…”

Section: Introductionmentioning

confidence: 99%

Regional analgesia in Italy: A survey of current practice

Allegri

Niebel

Bugada

et al. 2010

Eur Journal of Pain Supp

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Two decades of attention have focused on regional anesthesia, both central neuraxial blockades as well as peripheral blocks. Though there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anesthesia on outcome have not been completely resolved, possibly because the data are often not procedure‐specific. In this survey, we tried to focus on current Italian practice and therapeutical criteria in the management of postoperative pain. We also evaluated how the clinical practice of the respondents follows the international and national guidelines for postoperative pain. A questionnaire was mailed to 64 anesthesiologists who had been identified from a database kept by the RICALOR Group (Registro Italiano Complicanze Anestesia LOcoRegionale — Italian Registry of Complications during Locoregional Anesthesia). The survey requested information regarding demographic data and general management, postoperative pain management and guidelines, and specific questions on epidural analgesia and on peripheral blocks. Only 35 of the 64 anesthesiologists answered the questionnaire and sended it back for analysis. Basing on these 35 returns, data from 51 surgical units (some respondent referred data of more surgical units) leading to 135 departments (surgical units may be constituted by more departments) were analyzed. A total of 245,382 surgical procedures were analyzed. Regional analgesia was used in 46.71% of the procedures. In university and teaching‐hospitals, protocols concerning regional anesthesia were attended and shared with the whole staff more often than in non‐teaching hospitals (P = 0.0001). For postoperative pain management 31.48% of responders used <10% of regional analgesia, 20.37% used 10–30%, 25.93% used 30–50%, 14.81% used 50–75% and 7.41% used >75% of regional analgesia. We identified a huge variety of responses regarding therapeutical protocols but the majority of responders used the drugs with the best safety/efficacy profile. In conclusion, we demonstrated an improvement in the management of postoperative pain compared to previous studies, but still efforts should be made to standardize daily practice in order to avoid complications and improve safety.

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Die chirurgischen Fallberichte des Hippokrates von Kos

Golder,

Golder

2024

MMW Fortschr Med

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“Above All, Do No Harm”

Cited by 5 publications

References 12 publications

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block

Regional analgesia in Italy: A survey of current practice

Die chirurgischen Fallberichte des Hippokrates von Kos

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