Analgesic effect of Ropivacaine combined with Dexmedetomidine on brachial plexus block

Abstract

BackgroundThis randomized controlled study investigated the analgesic effect of ropivacaine in combination with dexmedetomidine versus ropivacaine alone on brachial plexus block to provide alternative anesthetic means for upper limb trauma surgery.MethodsTotally 114 patients who received upper limb surgeries under brachial plexus block anesthesia in our hospital from February 2013 to July 2015 were enrolled. The patients were randomized to ropivacaine alone (the control group) or ropivacaine combined with dexmedetomidine (the combination group). The blocking effect on sensory and motor neurons, visual analog scale (VAS) score, heart rate (HR), mean arterial pressure (MAP), peripheral capillary oxygen saturation (SPO2) and adverse reactions were compared between the two groups.ResultsThe time to onset of sensory and motor nerve blockade was significantly shorter in the combination group than in the control group (8.9 min vs. 12.4 min for sensation blockade; 7.5 min vs. 12.8 min for motor blockade, P < 0.05 for both comparisons), and the duration of the blockade was significantly longer in the combination group (590.2 min vs. 532.1 min, P < 0.05). There was no significant difference in VAS scores between the two groups immediately and 4 h after surgery; however, 8, 12 and 24 h after surgery, the VAS scores were all significantly lower in the combination group than the control group (2.4 vs. 3.0 for 8 h; 2.2 vs. 4.2 for 12 h, and 2.1 vs. 5.4 for 24 h, respectively, P < 0.05 for all comparisons). There was no statistical difference in HR, MAP and SPO2 between the two groups before anesthesia, but after anesthesia, the MAP and HR were significantly lower, and the SPO2 was significantly higher in the combination group than the control group (78 vs. 84 for MAP; 72 vs. 79 for HR; and 95.1 vs. 88.2 for SPO2, P < 0.05 for all comparisons). The rates of adverse reaction was significantly lower in the combination group than the control group (3.6 vs. 7.2, P < 0.05).ConclusionThe brachial plexus blocking effect of ropivacaine combined with dexmedetomidine was superior to that of ropivacaine alone, mainly intra-operatively and postoperatively.Trial registrationAnalgesic Effect of Ropivacaine Combined with Dexmedetomidine on Brachial Plexus Block, ChiCTR1800017372, retrospectively registered on July 26, 2018.

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

“…Epidural or perineural DEX has been used in the range of 0.5~1 μg/kg without any incidence of neurological deficits [18–20]. Even a higher dose (150 μg) DEX was added to ropivacaine for interscalene brachial plexus blocks, there were no acute or delayed neurological sequelae, and no significant adverse events [13]. It is reported that the addition of 1 μg/kg DEX to bupivacaine for caudal block has less adverse effect on the cardiovascular system in pediatrics [21].…”

“…Bhardwaj et al found that DEX plus ropivacaine for the surgical wound infiltration significantly alleviated postoperative pain and decreased the dose of rescue analgesic in patients undergoing lower segment cesarean section [12]. It is also shown that DEX added to ropivacaine extends the duration of brachial plexus blocks and improves postoperative pain [13]. When DEX is intravenously administrated during laparoscopic surgery, it significantly blunts stress response related to surgery and maintains haemodynamic stability [5].…”

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

“…Epidural or perineural DEX has been used in the range of 0.5~1 µg/kg without any incidence of neurological deficits [18][19][20]. Even a higher dose (150 µg) DEX was added to ropivacaine for interscalene brachial plexus blocks, there were no acute or delayed neurological sequelae, and no significant adverse events [13]. It is reported that the addition of 1 µg/kg DEX to bupivacaine for caudal block has less adverse effect on the cardiovascular system in pediatrics [21].…”

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

“…Bhardwaj et al found that DEX plus ropivacaine for the surgical wound infiltration significantly alleviated postoperative pain and decreased the dose of rescue analgesic in patients undergoing lower segment cesarean section [12]. It is also shown that DEX added to ropivacaine extends the duration of brachial plexus blocks and improves postoperative pain [13].…”