Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

Abstract

Background: The effect of dexmedetomidine as an adjuvant in the adductor canal block (ACB) and sciatic popliteal block (SPB) on the postoperative tramadol-sparing effect following spinal anesthesia has not been evaluated. Methods: In this randomized, placebo-controlled study, ninety patients undergoing below knee trauma surgery were randomized to either the control group, using ropivacaine in the ACB + SPB; the block Dex group, using dexmedetomidine + ropivacaine in the ACB + SPB; or the systemic Dex group, using ropivacaine in the ACB + SPB + intravenous dexmedetomidine. The primary outcome was a comparison of postoperative cumulative tramadol patient-controlled analgesia (PCA) consumption at 48 hours. Secondary outcomes included time to first PCA bolus, pain score, neurological assessment, sedation score, and adverse effects at 0, 5, 10, 15, and 60 minutes, as well as 4, 6, 12, 18, 24, 30, 36, 42, and 48 hours after the block. Results: The mean ± standard deviation of cumulative tramadol consumption at 48 hours was 64.83 ± 51.17 mg in the control group and 41.33 ± 38.57 mg in the block Dex group (P = 0.008), using Mann-Whitney U-test. Time to first tramadol PCA bolus was earlier in the control group versus the block Dex group (P = 0.04). Other secondary outcomes were comparable. Conclusions: Postoperative tramadol consumption was reduced at 48 hours in patients receiving perineural or systemic dexmedetomidine with ACB and SPB in below knee trauma surgery.

Analgesic effect of dexmedetomidine in colorectal cancer patients undergoing laparoscopic surgery

“…Keywords: cancer, colon, dexmedetomidine, pain, postoperative Saudi Med J 2022; Vol. 43 (10) D espite remarkable developments in minimally invasive surgical techniques and understanding of pain mechanisms, postoperative pain remains a serious issue. 1 Surgical tissue and neural damage activate nociceptive neurons, leading to peripheral and central sensitization.…”

“…8 Dexmedetomidine )DEX(, a highly selective and potent agonist of alpha-2 adrenoreceptors, acts on neuropathic pain modulation. 9,10 It has sedative, sympatholytic, and analgesic effect. 11 Dexmedetomidine inhibits norepinephrine release from synaptic neurons via alpha-2 receptors in rostral pons and central pain modification by enhancing the inhibitory descending pain pathway.…”

Re: Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

“…And it can achieve an appropriate level of sedation without respiratory depression. Especially, the efficacy of dexmedetomidine when combined with regional anesthesia includes increasing the quality of regional anesthesia, prolongation of the duration of analgesia, and having an opioid-sparing effect postoperatively [2].…”

“…We have carefully read with great concern the article entitled “Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial.” published in The Korean Journal of Pain by Ahuja et al [ 2 ]. Their results showed that perineurally or intravenously administered dexmedetomidine reduced postoperative tramadol consumption in patients undergoing lower extremity surgery when combined with sciatic popliteal and adductor canal analgesia.…”

The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial

“…Administration of continuous regional analgesia, however, is technically cumbersome and not suitable for ambulatory anesthesia in some countries, making adjunctive agents more attractive. Intravenous adjunctive agents are free of concerns regarding "off label use" and have been shown to be as effective as perineural injection [12][13][14][15][16].…”