Dexamethasone or Dexmedetomidine as Local Anesthetic Adjuvants for Ultrasound-guided Axillary Brachial Plexus Blocks with Nerve Stimulation

Abstract

BackgroundThe purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB).MethodsFifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml (100 µg) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed.ResultsThe duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups.ConclusionsDexamethasone 10 mg and dexmedetomidine 100 µg were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time.

The Effect of Adding Dexmedetomidine as an Adjuvant to Lidocaine in Forearm Fracture Surgeries by Supraclavicular Block Procedure Under Ultrasound-Guided

“…This study is consistent with the finding of Lee et al, Esmaoglu et al and Das et al, which showed that the use of DEX as an adjuvant to local anesthesia decreases analgesic consumption dose ( 20 - 22 ).…”

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

“…the axillary BPB prolonged the duration of both sensory and motor nerve blocks without any major side effects [24]. Some investigators demonstrated that adding dexamethasone or dexmedetomidine to LAs during axillary BPBs extended the sensory block duration with no significant differences regarding the onset time of sensory block or postoperative complications [10].…”

“…Dexmedetomidine is a highly selective alpha-2 adrenergic agonist with both analgesic and sedative effects. Perineural injection of dexmedetomidine prolonged the time span of both sensory and motor blocks when added to LAs during the brachial plexus block (BPB) [10]. Many investigators reported faster onset and longer duration of the sensory block when using dexmedetomidine for the greater palatine, axillary brachial, and ulnar nerve blocks [11].…”

Efficacy of adjuvant dexmedetomidine in supraclavicular brachial plexus block for intractable complex regional pain syndrome: A case report with a 3‐year follow‐up

“…Dexmedetomidine (DEX), a potent and selective α 2 adrenoceptor agonist, was recently shown to prolong analgesic duration when added to local anaesthetics in regional anaesthesia . This effect is related to the enhancement of hyperpolarization‐activation cation currents, which prevents the nerve from returning to resting membrane potential from a hyperpolarized state and subsequent firing .…”

“…6 Dexmedetomidine (DEX), a potent and selective α 2 adrenoceptor agonist, was recently shown to prolong analgesic duration when added to local anaesthetics in regional anaesthesia. [8][9][10][11] This effect is related to the enhancement of hyperpolarization-activation cation currents, which prevents the nerve from returning to resting membrane potential from a hyperpolarized state and subsequent firing. 12 Ghobadifar et al 13 reported that intrathecal DEX may play an important role in mitigating neuropathic pain.However, there has been no report on the effect of long-term repeated usage of DEX in conjunction with local anaesthetics in BPB for CRPS.…”