Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits local inflammatory response

Li, Jing; Wang, Hanghui; Dong, Birong; Ma, Jianbing; Wu, Xucai

doi:10.23736/s0375-9393.17.11430-6

Cited by 18 publications

(14 citation statements)

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“…Dexmedetomidine (DEX), a highly selective alpha-2 receptor agonist, has sedative, analgesic, and anti-anxiety effects during anesthesia [ 1 ] via various mechanisms, including perineural [ 2 , 3 ], intra-articular [ 4 , 5 ], and systemic administration [ 6 ]. As a new adjuvant to nerve block, the perineural route for DEX can provide advantages in prolonged analgesia and inhibition of local inflammatory response [ 7 , 8 ]. In addition, studies have shown that the systemic administration of DEX enhances analgesic effects and sleep quality [ 9 , 10 ], dampens surgical stress and the inflammatory response [ 11 , 12 ], reduces the incidence of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) [ 13 – 15 ], and prolongs the duration of peripheral nerve block in patients with unilateral arthroscopic shoulder surgery [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty

et al. 2021

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Introduction: Dexmedetomidine (DEX) as a nerve block adjuvant can significantly prolong analgesia. However, whether perineural or systemic administration of DEX is more beneficial in patients undergoing total knee arthroplasty (TKA) has not been thoroughly investigated. To this end, we evaluated the effects of perineural and systemic DEX administration on postoperative analgesia in patients undergoing TKA surgery. Methods: We randomly assigned patients undergoing TKA under general anesthesia combined with femoral nerve block and sciatic nerve block to one of three groups: (1) ropivacaine plus perineural dexmedetomidine (DP): 0.25% Xiao-bin Jin, Rui Xiao and Wei Zhou contributed equally to this paper.

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Section: Introductionmentioning

confidence: 99%

Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty

et al. 2021

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“…Clinicians often report that it would be preferable if during the sedation the patient could be easily awoken with verbal stimulus and be oriented and cooperative. Such effects of dexmedetomidine have already been elucidated in previous studies ( 19 , 25 ). This implies that perineural dexmedetomidine has a high potential for patient and clinician satisfaction.…”

Section: Discussionmentioning

confidence: 52%

“…Dexmedetomidine has been recently proven to be an effective adjuvant to regional anaesthesia ( 12 – 15 ) Perineural administration of dexmedetomidine alongside local anesthetics is advantageous for prolonged surgery and provides long-duration postoperative analgesia ( 12 , 17 , 19 ). In the present study, DG patients demonstrated safe and comfortable systemic sedative effect after 100 mcg of dexmedetomidine added perineurally in ABPB for wrist surgery.…”

Section: Discussionmentioning

confidence: 99%

Perineural Administration of Dexmedetomidine in Axillary Brachial Plexus Block Provides Safe and Comfortable Sedation: A Randomized Clinical Trial

et al. 2022

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Dexmedetomidine prolongs the duration of regional block while its systemic sedative effect when administered perineurally is unknown. We aimed to evaluate the systemic sedative effect of perineural dexmedetomidine in patients after axillary brachial plexus block (ABPB). This single-blinded prospective randomized control trial included 80 patients undergoing wrist surgery receiving ABPB. Patients were randomized into two groups – Control group (CG, N = 40) and dexmedetomidine group (DG, N = 40). Both groups received ABPB with 20 ml of 0.5% Bupivacaine and 10 ml of 2% Lidocaine. Additionally, patients in DG received 100 mcg of dexmedetomidine perineurally. Depth of sedation was evaluated using Narcontrend Index (NI) and Ramsay Sedation Scale (RSS) immediately after ABPB and in several time points up to 120 min. Duration of block as well as patient satisfaction with sedation was evaluated using a postoperative survey. Our results showed that NI and RSS statistically differed between groups, presenting a deeper level of sedation during the first 90 min in DG compared to controls, P < 0.001. In the first 10 to 60 min after ABPB the median RSS was 4 (IQR within median) and median NI was 60 (IQR 44–80) in DG group, in contrast to CG patients where median RSS was 2 (IQR within median) and median NI was 97 (IQR 96–98) throughout surgery. The level of sedation became equal in both groups 90 and 120 min after ABPB when the median NI value was 98 (97–99) in DG and 97.5 (97–98) in CG, P = 0.276, and the median RSS was 2 (IQR within median) in both groups, P = 0.128. No significant intergroup differences in hemodynamic or respiratory parameters were found. Patients in DG expressed satisfaction with sedation and 86.5% noted that the sensation was similar to ordinary sleep. In DG mean duration of motor block was 13.5 ± 2.1 h and sensory block was 12.7 ± 2.8 h which was significantly longer compared to CG 6.3 ± 1.5 h, P < 0.001 and 6.4 ± 1.8 h, P < 0.001. We found that beside prolongation of analgesia, perineural administration of dexmedetomidine might provide rather safe and comfortable sedation with no significant effect on hemodynamic or respiratory stability and yields a high level of patient satisfaction.

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“…Huang et al 18 found that injecting 20 μg/kg of dexmedetomidine around the sciatic nerve in rats reduced inflammatory cytokines interleukin-6, tumor necrosis factor alpha, and the local inflammatory reaction by inhibiting the nuclear factor kappa-light-chain-enhancer of the activated B-cell signaling pathway. Li et al 19 revealed that a femoral nerve block with 1 μg/kg of dexmedetomidine combined with ropivacaine had a better peripheral anti-inflammatory effect and pain control after total knee arthroplasty than ropivacaine only. The vasoconstrictive effect of dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

Yang¹,

Zhao²,

Zhang³

et al. 2022

DDDT

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Objective This study aimed to investigate the effect of ropivacaine with dexmedetomidine or dexamethasone in a thoracic paravertebral nerve block (TPVB) combined with an erector spinae plane block (ESPB) for thoracoscopic lobectomy analgesia. Methods A total of 97 patients undergoing thoracoscopic lobectomy under general anesthesia were enrolled in this study and randomly divided into three groups, ie, a ropivacaine group (Group R), a ropivacaine + dexmedetomidine group (Group R1), and a ropivacaine + dexamethasone group (Group R2). Ultrasound-guided TPVB combined with an erector spinae plane block was given after anesthesia induction. The following were applied to each group: Group R received 30 mL of 0.5% ropivacaine + 5 mL of a normal saline mixture; Group R1 received 30 mL of 0.5% ropivacaine + 5 mL of a 1 μg/kg dexmedetomidine mixture; Group R2 received 30 mL of 0.5% ropivacaine + 5 mL of an 8 mg dexamethasone mixture. The primary observation index was the time to the first postoperative remedial analgesia. The secondary observation indexes were the intraoperative consumption of propofol and sufentanil, time to waking from anesthesia, time to extubation, postoperative numerical rating scaltpe (NRS) score, postoperative sufentanil consumption, remedial analgesic dosage, and adverse reactions. Results When compared with Group R, the time to first postoperative remedial analgesia was longer, the intraoperative and postoperative sufentanil consumption and flurbiprofen axetil remedial analgesic dose were lower, and the time to waking from anesthesia and time to extubation were shorter in groups R1 and R2 (P < 0.05). The NRS scores at 1, 6, 12, and 24 h postoperatively in groups R1 and R2 were lower than in Group R at the same time points (P < 0.05). Conclusion Ropivacaine with dexmedetomidine or dexamethasone in TPVB combined with ESPB could prolong the time to first postoperative remedial analgesia, reduce perioperative sufentanil and postoperative remedial analgesic drug consumption, and decrease the postoperative NRS score in patients undergoing thoracoscopic lobectomy.

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Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits local inflammatory response

Cited by 18 publications

References 0 publications

Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty

Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty

Perineural Administration of Dexmedetomidine in Axillary Brachial Plexus Block Provides Safe and Comfortable Sedation: A Randomized Clinical Trial

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

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