Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Meena, Rajesh Kumar; Loha, eep; P, Arun Raj; ey,; Meena, Kavita; Paswan, Anil Kumar; Chaudhary, Lalita; Prakash, S.

doi:10.4172/2155-6148.1000674

Cited by 5 publications

(11 citation statements)

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“…The full‐text manuscripts of the remaining 312 studies were assessed. After including studies from hand searches and revision of search, we identified a total of 100 studies for inclusion in this network meta‐analysis [32–131]. The study flow chart is in online Supporting Information Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, pairwise meta‐analysis of 53 trials for sensory block duration [73–111, 113–122, 125, 126, 128, 129] and 53 trials for motor block duration [73–111, 113–122, 125, 126, 128, 129] comparing perineural dexmedetomidine vs. control arms did not reveal any sub‐group differences by indexing status (see online Supporting Information). Consequently, indexed and non‐indexed papers were pooled and analysed in the network, as decided a priori.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐eight articles were peer‐reviewed and indexed trials [32, 34, 36–38, 42, 44, 53, 54, 58, 59, 63, 66, 69, 72, 75, 79, 81–84, 94, 96, 99, 102, 105, 107, 109, 110, 113–116, 123, 124, 127–129], while 62 articles were peer‐reviewed, non‐indexed publications [33, 35, 39–41, 43, 45–52, 55–57, 60–62, 64, 65, 67, 68, 70, 73, 74, 76–78, 80, 83, 85–93, 95, 97, 98, 100, 101, 103, 104, 106, 108, 111, 112, 117–122, 125, 126, 130, 131]. Fifty‐four trials used bupivacaine as their long‐acting local anaesthetic [32–35, 38, 40–44, 46–48, 50, 51, 54, 55, 57–59, 61, 62, 64–66, 68–72, 76, 77, 79, 85, 89–91, 93, 94, 98–101, 103, 104, 106, 112, 116–118, 122, 124–126], 14 used levobupivacaine [37, 45, 63, 73, 78, 82, 83, 86, 87, 97, 109, 111, 115, 121] and 32 used ropivacaine […”

Section: Resultsmentioning

confidence: 99%

“…For the primary outcome, sensory block duration, 20 studies were judged to have a low risk of bias [35, 38, 39, 42, 45, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 61 studies had some risk of bias [33, 34, 36, 37, 43, 47, 48, 52, 55, 57, 58, 61, 67, 68, 70, 71, 73–75, 77–80, 83–85, 87–91, 95–106, 108, 109, 111, 114, 117–123, 125–131] and 4 studies were at high risk of bias [41, 63, 86, 124].…”

Section: Resultsmentioning

confidence: 99%

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Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

et al. 2020

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Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

et al. 2020

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“…Although different approaches are available but we selected supraclavicular approach as it is a simple and safe technique for anesthesia and analgesia for surgeries below the shoulder joint. 11 In these blocks various drugs like clonidine, buprenorphine, ketamine and dexmedetomidine have been used as adjuvants to local anesthetic drugs to speed up the onset, prolong the duration and improve the quality of block. 12 Dexmedetomidine has been used as perineural adjuvant to local anesthetic drugs in different regional and peripheral nerve blocks and has been proven to be an excellent choice in potentiating local anesthetic effect.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Khaleeq

Azam

Siddiq

et al. 2020

APMC

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Objective: Brachial plexus block is one of the commonly used anesthetic technique for upper limb procedures in orthopedics. A number of drugs have been used as adjuvants to local anesthetic agents, to prolong the duration and enhance the quality of the block. Some of these are clonidine, dexmedetomidine, ketamine, dexamethasone and magnesium sulfate. We conducted this study to evaluate dexmedetomidine and dexamethasone with respect to the onset and duration of sensorimotor block. Their effects on hemodynamic parameters as well as duration of analgesia after surgery were also recorded. Study Design: Prospective Randomized controlled design. Settings: Anesthesia, ICU and pain management department of Services Hospital/SIMS, Lahore Pakistan. Duration: From 15th September 2019 till 15th March 2020. Methodology: Sixty patients fulfilling the inclusion criteria were enrolled in the study after taking informed written consent for upper limb procedures under supraclavicular brachial plexus block. These patients were divided into two groups BD and BG with 30 patients in each group. Patients in Group BD received 32ml of 0.375% bupivacaine (30 ml) with 100microgram of dexmedetomidine(2ml). Group BG patients received 32ml of 0.375% bupivacaine(30ml) with 8mg of dexamethasone (2ml). The onset and duration of sensory and motor block, time to request for first rescue analgesic and hemodynamic changes in both groups of patients were recorded. Results: The results of our study revealed that the patients in group BD had earlier onset and longer duration of sensory and motor block with minimal hemodynamic changes. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant, in terms of rapid onset and prolonged duration of sensorimotor block and postoperative analgesia after supraclavicular block, with minimal hemodynamic changes.

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Evaluation of the role of diffusion-weighted imaging in various pancreatic pathologies

Deepak Chakravarthy SS,

Gopinath Subashini,

Ganesan Gopinath

et al. 2023

Asian J Med Sci

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Background: Diffusion-weighted imaging (DWI) can confidently characterize the nature of a lesion. “Apparent diffusion coefficient” (ADC) has a role in evaluating malignant lesions of the pancreas when conventional sequences appear normal. Aims and Objectives: The aim of the study was to determine the role of DWI and ADC to differentiate benign from malignant pancreatic lesions. Materials and Methods: An observational study was carried out on 75 participants with a suggestion of pancreatic pathologies at a tertiary care institute. Twenty-five participants, who had normal parenchyma of the pancreas, were taken as controls. Magnetic resonance imaging protocol was done, including DWI and ADC. Data analysis was done using coGuide software. ADC was the primary outcome of interest. Results: Out of the 75 cases, 76.9 % (n=60) were males. 15.4 % (n=9) of pathologies were malignant. A significant decrease of ADC values in subjects with acute diffuse pancreatitis (1.12×10-3), acute on chronic pancreatitis (1.14×10-3), chronic pancreatitis (1.32×10-3) as well as adenocarcinoma pancreas (0.92×10-3) was seen in comparison to the controls (1.41×10-3). ADC values for acute pancreatitis, chronic pancreatitis, and acute on chronic pancreatitis were significantly higher than malignancy. Conclusion: DWI and ADC is a useful tools complementing conventional MR imaging and other imaging modalities in characterizing pancreatic pathologies. Mean ADC values of various pancreatic diseases can be determined without major overlap and a reasonable cutoff value can be obtained for differentiating benign and malignant lesions.

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Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Cited by 5 publications

References 0 publications

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

Comparison of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Evaluation of the role of diffusion-weighted imaging in various pancreatic pathologies

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