Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block: A prospective randomized double-blinded clinical trial

Abstract

Background:Addition of dexmedetomidine to ropivacaine for peripheral nerve blocks has shown to improve the efficacy of ropivacaine by prolonging the duration of analgesia. This study was undertaken to evaluate the effects of ropivacaine alone and in combination with dexmedetomidine in the axillary block.Materials and Methods:A total of 80 patients belonging to American Society of Anesthesiologists physical status I, II, and III, scheduled for elective forearm and/or hand surgeries were randomly allocated into one of the two groups to receive either 39 ml of 0.375% ropivacaine and 1 ml normal saline (Group R) or 39 ml of 0.375% ropivacaine and 1 μg/kg dexmedetomidine diluted to 1 ml with normal saline (Group RD).Results:There was a significant early the onset of sensory and the motor block in Group RD. Duration of sensory block in Group RD was 677.25 ± 99.64 min and in Group R was 494.38 ± 70.64 min and the difference was clinically significant (P < 0.001). Duration of motor block in Group RD was 712.88 ± 89.32 min and in Group R was 526.25 ± 70.229 min and was clinically significant. Duration of analgesia in Group RD was 764.38 ± 110.275 min and that in Group R was 576.88 ± 76.306 min and was clinically significant. There was a significant alteration in hemodynamics in Group RD when compared to Group R without any side effects.Conclusion:Dexmedetomidine as an adjuvant to ropivacaine provides quicker onset of anesthesia, longer duration of analgesia. It offers convenient, simple, effective mode of anesthesia, and postoperative analgesia for forearm and/or hand surgeries.

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

“…Only 6 studies reported the duration of analgesia and had complete data to pooling. [ 12 , 14 , 17 , 19 , 20 , 22 ] The result indicated that dexmedetomidine as an adjuvant prolonged the duration of analgesia significantly by an average of 303.04 minutes compared with the control group (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes, I 2 = 86%; P < .00001) (Fig. 7 ).…”

Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks

“…There were 515 patients in the DEX group and 499 patients in the control group among all 18 studies. [ 16 , 22 – 38 ] The definition of duration of sensory block varied from time interval between LA administration or complete sensory block to complete sensory recovery. Pooled analysis showed significantly prolonged sensory block duration when combined with DEX (WMD 257 minutes, 95%CI 191.79–322.24, P < 0.001), compared with that without DEX, as shown in Fig.…”

“…There were 498 patients in the DEX group and 482 patients in the control group among 17 studies, [ 16 , 22 – 35 , 37 , 38 ] whereas 1 study was excluded without detailing motor block. The definition of duration of motor block varied, mostly defined as the time interval between LA administration to complete motor sensory recovery.…”

“…The onset of sensory and motor block was reported in 18 [ 16 , 22 – 38 ] and 15 [ 16 , 22 – 28 , 30 , 32 – 35 , 37 , 38 ] studies, respectively. Pooled analysis showed that perineural DEX accelerated the onset of sensory block (WMD –3.34 minutes, 95%CI –4.61 to –2.07, P < 0.001) (Fig.…”

Dexmedetomidina como coadyuvante en bloqueos de nervio periférico

“…En primer lugar, destacar que todos los artículos analizados corresponden a ECR que compararon resultados de bloqueos de nervio periférico con y sin uso de DEX perineural en diferentes abordajes de plexo braquial. En líneas generales, los trabajos analizados son bastante heterogéneos entre sí cuanto a contexto quirúrgico y metodología anestésica, aun así, la mayoría presentan un nivel moderado-alto en cuanto a calidad de evidencia (según escala GRADE) así como nivel moderado-bajo de sesgo (según escala COCHRANE) (18,20,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Dado que la mayoría de los ensayos clínicos implicaron el uso de anestesia general e instalación de catéter para bloqueo continuo de nervio periférico, no se pudo estudiar adecuadamente los tiempos de latencia y, por ello, no se evaluó este punto en este subgrupo.…”