Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

The brachial plexus is often a target of regional anesthesia for procedures involving the upper extremities. These include the supraclavicular, infraclavicular, interscalene, and axillary blocks. The cases we present involve the use of an ultrasound-guided interscalene block using 20 mL 0.2% ropivacaine with dexamethasone and 25 mcg dexmedetomidine as the injectate. This particular block technique has proven to be a very useful adjunct to the perioperative anesthetic care and enhanced recovery after surgery (ERAS) protocol for these patients. The series of cases we present include patients receiving the dexamethasone and dexmedetomidine (Dex-Dex) combination in their local anesthetic injectate for the ultrasound-guided interscalene block. Two of the patients underwent arthroscopic shoulder procedures and one underwent a shoulder total arthroplasty with biceps tenodesis. None of the patients required any postoperative opioids for analgesia. Though the technique is fairly new, with only a limited number of case studies described its efficacy, the understanding of the benefits of ERAS has helped it gain some traction in the field of regional anesthesia. Conduction of further large clinical trials is the next step in providing a better understanding of the Dex-Dex adjuvant method as it moves towards becoming a commonly used component of ERAS protocols in the perioperative period.

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Synergistic Effect of Perineural Dexamethasone and Dexmedetomidine (Dex-Dex) Prolong Analgesic Effect of a Preoperative Interscalene Block

Noor

Urits

Viswanath

et al. 2020

“…Another study observed the effect of the Dex-Dex block in intercostal nerve blocks for thoracoscopic pneumonectomy. Zhang et al found that patients who received the Dex-Dex combination had approximately 3.5 more hours of postoperative pain relief and required significantly less fentanyl after surgery when compared to dexmedetomidine and dexamethasone groups [ 6 ]. Additionally, other case reports have demonstrated a prolonged analgesic effect when using the Dex-Dex combination in interscalene and transversus abdominis plane blocks [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Synergistic Effect of Perineural Dexamethasone and Dexmedetomidine (Dex-Dex) in Extending the Analgesic Duration of Pectoral Type I and II Blocks

Zusman¹,

Urits²,

Kaye³

et al. 2020

Pectoral type I and II (Pecs I and II) blocks are regional anesthesia methods that have shown to decrease postoperative analgesia after breast surgery. Typically, these blocks consist only of a local anesthetic. We performed preoperative Pecs I and II blocks in a female patient undergoing surgical excision and biopsy of a breast mass. The anesthetic consisted of ropivacaine, dexmedetomidine, and dexamethasone (Dex-Dex). The patient experienced an extended postoperative pain relief period. She did not require any opiates postoperatively. Adding dexmedetomidine and dexamethasone to a local anesthetic for peripheral nerve blocks seems to have a synergistic effect and can extend the duration of pain relief. This combination has the potential to decrease postoperative opiate requirements for analgesia. Further studies need to be conducted to further determine the safety and efficacy of the Dex-Dex block.

“…Our case illustrates the synergistic effect of a Dex-Dex adjuvant combination with local anesthetic injectate when used in a regional fascial plane block. Zhang et al found the analgesic effect to be prolonged with the use of the Dex-Dex technique for the intercostal nerve block [ 3 ]. Similarly improved and prolonged analgesia was demonstrated by using the Dex-Dex adjuvant for interscalene nerve blocks for surgeries of the upper extremity [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Zhang et al provide one of the few studies to date demonstrating the efficacy of the Dex-Dex combination in PNB, which in their case was for an intercostal nerve block. They concluded that patients who received the Dex-Dex combination in the PNB experienced prolonged perioperative analgesia with no significant increase in adverse outcomes when compared to the groups only receiving PNB and no adjuvants, PNB with only dexamethasone, or PNB with only dexmedetomidine [ 3 ]. There are also a limited number of case reports in the literature supporting the claim that there exists a synergistic effect on the PNB’s duration of action that significantly supersedes the efficacy of using either one of these adjuvants alone [ 1 , 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Fascia Iliaca Block Successfully Prolonged With Dexmedetomidine and Dexamethasone for Pain Control in a Patient Undergoing Total Hip Arthroplasty

Noor

Urits

Viswanath

et al. 2020

Regional anesthesia has found many advocates as enhanced recovery after surgery continues to become a more popular option for procedures such as total hip arthroplasty. Among the many benefits is the better pain control with a reduction or complete elimination of the need for opioids for perioperative pain management. With aims to improve the multi-modal approach to pain management, we present a case demonstrating further improvements in the regional anesthetic technique with the addition of a dexamethasone and dexmedetomidine adjuvant to the local anesthetic injectate. Our case is that of a 65year-old woman with a history of hypertension, hyperlipidemia, and right hip osteoarthritis undergoing a right total hip arthroplasty who received a preoperative ultrasound-guided fascia iliaca block with the adjuvants dexamethasone and dexmedetomidine added to the injectate. The surgery was uneventful. She did not require any postoperative opioid or non-opioid analgesics, denying any pain for the first three postoperative days.