Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Pande, Aparna; Sen, Indu; Gupta, Amrita; Gupta, Ankur; Sharma, Ashish

doi:10.1016/j.bjane.2021.10.012

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Gupta et al 21 revealed that ropivacaine plus dexamethasone could significantly prolong the postoperative analgesic time during an abdominal transverse plane block. Pande et al 22 also revealed that the analgesic time of a supraclavicular brachial plexus block could be significantly prolonged by adding a low dose of dexamethasone to the local anesthetic solution. Mao et al 23 revealed that, as an adjuvant of ropivacaine for TPVB, dexamethasone could significantly reduce the dosage of perioperative anesthetic drugs, effectively control postoperative acute pain, reduce postoperative complications, shorten rehabilitation time, and reduce the incidence of chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

Yang¹,

Zhao²,

Zhang³

et al. 2022

DDDT

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Objective This study aimed to investigate the effect of ropivacaine with dexmedetomidine or dexamethasone in a thoracic paravertebral nerve block (TPVB) combined with an erector spinae plane block (ESPB) for thoracoscopic lobectomy analgesia. Methods A total of 97 patients undergoing thoracoscopic lobectomy under general anesthesia were enrolled in this study and randomly divided into three groups, ie, a ropivacaine group (Group R), a ropivacaine + dexmedetomidine group (Group R1), and a ropivacaine + dexamethasone group (Group R2). Ultrasound-guided TPVB combined with an erector spinae plane block was given after anesthesia induction. The following were applied to each group: Group R received 30 mL of 0.5% ropivacaine + 5 mL of a normal saline mixture; Group R1 received 30 mL of 0.5% ropivacaine + 5 mL of a 1 μg/kg dexmedetomidine mixture; Group R2 received 30 mL of 0.5% ropivacaine + 5 mL of an 8 mg dexamethasone mixture. The primary observation index was the time to the first postoperative remedial analgesia. The secondary observation indexes were the intraoperative consumption of propofol and sufentanil, time to waking from anesthesia, time to extubation, postoperative numerical rating scaltpe (NRS) score, postoperative sufentanil consumption, remedial analgesic dosage, and adverse reactions. Results When compared with Group R, the time to first postoperative remedial analgesia was longer, the intraoperative and postoperative sufentanil consumption and flurbiprofen axetil remedial analgesic dose were lower, and the time to waking from anesthesia and time to extubation were shorter in groups R1 and R2 (P < 0.05). The NRS scores at 1, 6, 12, and 24 h postoperatively in groups R1 and R2 were lower than in Group R at the same time points (P < 0.05). Conclusion Ropivacaine with dexmedetomidine or dexamethasone in TPVB combined with ESPB could prolong the time to first postoperative remedial analgesia, reduce perioperative sufentanil and postoperative remedial analgesic drug consumption, and decrease the postoperative NRS score in patients undergoing thoracoscopic lobectomy.

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Section: Discussionmentioning

confidence: 99%

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

Yang¹,

Zhao²,

Zhang³

et al. 2022

DDDT

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“…Several adjuvants, such as adrenaline, dexamethasone, and dexmedetomidine, are commonly added to ropivacaine for BPB to achieve better analgesic effects ( Bharti et al, 2015 ; Kumari et al, 2020 ; Grelet et al, 2021 ; Lee et al, 2021 ; Mar et al, 2021 ; Pande et al, 2021 ; Venkatraman et al, 2021 ; Xuan et al, 2021 ). Therefore, we further explored the possible effects of adding adjuvants to ropivacaine on our results.…”

Section: Discussionmentioning

confidence: 99%

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

Wu,

Zhang,

Zhang

et al. 2023

Front. Pharmacol.

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Aim of the Study: Brachial plexus block (BPB) is widely used for patients undergoing upper limb surgeries. Ropivacaine is the most commonly used local anesthetic for BPB. This study aimed to identify the optimal ropivacaine concentration for BPB in adult patients undergoing upper limb surgeries.Materials and Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the effects of different concentrations of ropivacaine for BPB in adult patients undergoing upper limb surgeries. The primary outcomes were the onset time of sensory and motor block. RevMan 5.4 software was used for analysis. The GRADE approach was used to assess evidence quality.Results: Nine studies involving 504 patients were included. Compared to 0.5% ropivacaine, 0.75% ropivacaine shortened the onset time of sensory (WMD, −2.54; 95% CI; −4.84 to −0.24; <0.0001, moderate quality of evidence) and motor blockade (WMD, −2.46; 95% CI, −4.26 to −0.66; p = 0.01; moderate quality of evidence). However, 0.5% and 0.75% ropivacaine provided similar duration time of sensory (WMD, −0.07; 95% CI, −0.88 to 0.74; p = 0.81; high quality of evidence) and motor blockade (WMD, −0.24; 95% CI, −1.12 to 0.65; p = 0.55; high quality of evidence), as well as time to first request for oral analgesia (WMD, −1.57; 95% CI, −3.14 to 0.01; p = 0.5; moderate quality of evidence).Conclusion: Moderate-quality evidence suggested that, in terms of the onset time of sensory and motor blockade, 0.75% ropivacaine is a preferred concentration for BPB in upper limb surgeries.Systematic Review Registration: identifier CRD42023392145.

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“…Aparna Pande et al 9 studied low-dose dexamethasone 2mg as an adjunct to 0.5% ropivacaine and found a significant difference in the time of first analgesic request in dexamethasone group compared to the control group (432+/-43.8 min Vs 386.4+/-40.2min). The onset of sensory and motor block was faster in dexamethasone group and overall analgesic consumption was also reduced in dexamethasone group.…”

Section: Discussionmentioning

confidence: 99%

“…The use of dexamethasone may cause complications like hypergycemia, infection, impaired wound healing and neurotoxicity limiting its use in diabetics and immunocompromised patients. Dexamethasone has been associated with increase in postoperative blood glucose concentration in diabetic and nondiabetic patients 9 . So limiting the dose of steroids when used perineurally can minimize the side effects and broaden our spectrum of utility in diabetic patients with minimum side effects 10 .…”

mentioning

confidence: 99%

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2023

IJPSR

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Introduction: Ultrasound-guided axillary brachial plexus block is commonly used for forearm and hand surgery. Perineural dexamethasone 8mg has proved to prolong the duration of analgesia, but studies with low doses of dexamethasone are scarce. Hence this study was designed to determine the duration of analgesia with 2 mg dexamethasone used perineurally with ropivacaine. Methods: Fifty-Eight patients scheduled for forearm and hand surgeries were included in our study and randomly allocated into two groups. Group R-Axillary Brachial Plexus Block given with 0.75% Ropivacaine 18 ml and 2ml NS and Group RD-Axillary Brachial Plexus Block given with 0.75% Ropivacaine 18 ml and 2 mg Dexamethasone making a total volume of 20ml. Results: Four patients were excluded because of block failure. The time of first rescue analgesia in Group RD was 515.74±11.07 minutes and in Group R was 452.78±14.76 minutes and was statistically significant. Onset of sensory block and motor block in Group RD was earlier than in Group R and duration of sensory and motor block was also longer in Group RD. In Group RD, the VAS score at 8th hour was higher in Group R with 4.63 ±0.49 Vs 2.19±0.48. VAS score at 10th hour was higher in Group RD with 5 ±0.62 Vs 1.22±0.97 in Group R. There was a significant difference in the doses of rescue analgesia between both the groups with p value<0.001 with Group R requiring higher doses of rescue analgesia in 24 hours. Conclusion: A combination of 0.75% Ropivacaine with low dose dexamethasone can be used safely as an adjunct to local anaesthetic in patients with higher safety profile and also provides marginal prolongation of postoperative analgesia. INTRODUCTION:With the advent of ultrasound in recent years, ultrasound-guided axillary Brachial Plexus Block is commonly used for lower forearm and hand surgeries 1 .

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Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Cited by 5 publications

References 27 publications

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

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