Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair

Abstract

Purpose Suprascapular nerve block (SSNB) is the most commonly used block for the relief of postoperative pain from arthroscopic rotator cuff repair and can be used in combination with axillary nerve block (ANB). Dexmedetomidine (DEX) is a type of alpha agonist that can elongate the duration of regional block. The aim of this study was to compare the effects of the use of dexmedetomidine combined with SSNB and ANB with those of the use of SSNB and ANB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. Methods Forty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single-center, double-blinded randomized controlled trial study. Twenty patients were randomly allocated to group 1 and received ultrasound-guided SSNB and ANB using a mixture of 0.5 ml (50 μg) of DEX and 9.5 ml of 0.75% ropivacaine preemptively. The other 20 patients were allocated to group 2 and underwent ultrasound-guided SSNB and ANB alone using a mixture of 0.5 ml of normal saline and 9.5 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were postoperatively checked within 48 h. The plasma interleukin (IL)-6, IL-8, IL-1β, cortisol, and serotonin levels were also postoperatively measured within 48 h. Results Group 1 showed a significantly lower mean VAS (visual analog scale of pain) score 1, 3, 6, 12, 18 and 24 h after operation, and a significantly higher mean SAT (patient satisfaction) score 1, 3, 6, 12, 18, 24 and 36 h after the operation than group 2. Group 1 showed a significantly lower mean plasma IL-8 level 1 and 48 h after the operation, and a significantly lower mean IL-1β level 48 h after the operation than group 2. Group 1 showed a significantly lower mean plasma serotonin level 12 h after the operation than group 2. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (36 h > 23 h, p = 0.007). Six patients each in groups 1 and 2 showed rebound pain. The others did not show rebound pain. Conclusions Ultrasound-guided SSNA and ANB with DEX during arthroscopic rotator cuff repair resulted in a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h after the operation than SSNB and ANB alone. Additionally, SSNB and ANB with DEX tended to result in a later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1β, and serotonin levels within 48 h after the operation. The present study could provide the basis for selecting objective parameters of postoperative pain in deciding the optimal use of medication for relieving pain. Level of Evidence Level I. Trial Registration 2015–20, ClinicalTrials.gov Identifier: NCT04398589. IRB number 2015–20, Hallym University Chunc...

Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol

“…High-dose peripheral dexamethasone may also lead to a risk of wound infection and neurotoxicity ( 8 ). Perineural application of dexmedetomidine in arthroscopic rotator cuff repair can reduce postoperative pain scores and delay rebound pain during the first 48 post-surgical hours ( 9 , 10 ). Combining two or more nerve blocks and prolonging the block duration significantly reduces rebound pain and oral opioid use ( 11 – 13 ).…”

Regional nerve blocks for relieving postoperative pain in arthroscopic rotator cuff repair

“…Dexmedetomidine (DEX), a selective agonist of α2-adrenergic receptors, can be an effective adjuvant to local anesthetics for peripheral nerve blocks [ 22 , 23 ]. Preclinical and clinical studies have described a prolonged duration of analgesia when DEX was added to ropivacaine for regional nerve blocks [ 22 , 23 ].…”

“…Dexmedetomidine (DEX), a selective agonist of α2-adrenergic receptors, can be an effective adjuvant to local anesthetics for peripheral nerve blocks [ 22 , 23 ]. Preclinical and clinical studies have described a prolonged duration of analgesia when DEX was added to ropivacaine for regional nerve blocks [ 22 , 23 ]. One clinical trial found that ultrasound-guided ISB with DEX in ARCR led to a significantly lower mean VAS score and a significantly higher mean patient satisfaction score within 48 hours postoperatively, showing lower mean interleukin (IL)-6 and IL-8 levels than ISB alone with delayed rebound pain [ 22 ].…”

“…Another clinical trial reported that SSNB and ANB with DEX led to a similar effect as ISB with DEX. Additionally, SSNB and ANB with DEX resulted in later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1β, and serotonin levels within 48 hours after the operation [ 23 ].…”

“…There have also been studies that analyzed the effects of regional blocks (Table 1). Among these studies, randomized controlled trials are described in Table 2 [14][15][16][17][18][19][20][21][22][23][24]. In this review, we analyzed the effect of interscalene brachial plexus block (ISB), SSNB, and ANB.…”