Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Mathew, Sheena; Prasad, Shiva S.; Krishna, Rohith; Kumar, Abhijit; Shiyad, M

doi:10.4038/slja.v26i1.8261

Cited by 7 publications

(17 citation statements)

References 16 publications

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“…Only 6 studies reported the duration of analgesia and had complete data to pooling. [ 12 , 14 , 17 , 19 , 20 , 22 ] The result indicated that dexmedetomidine as an adjuvant prolonged the duration of analgesia significantly by an average of 303.04 minutes compared with the control group (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes, I 2 = 86%; P < .00001) (Fig. 7 ).…”

Section: Resultsmentioning

confidence: 96%

“…3 ). And adding dexmedetomidine to ropivacaine obviously decreased the time to sensory block onset both in groups with dosage greater [ 12 , 14 , 16 – 21 , 23 ] (MD, −2.97 minutes, 95% CI −4.94 to −1.01 minutes, I 2 = 86%; P = .003) and less [ 13 , 15 , 22 ] (MD, −6.96 minutes, 95% CI −11.85 to −2.06 minutes, I 2 = 86%; P = .005) than 50 μg (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

Dai

Tang

2018

Medicine

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Background:Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB).Methods:A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers.Results:Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], −3.86 minutes, 95% CI −5.45 to −2.27 minutes; I2 = 85%) and motor (MD, −5.21 minutes; 95% CI −7.48 to −2.94 minutes; I2 = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87–269.52 minutes; I2 = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48–230.91 minutes; I2 = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes; I2 = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI −0.02 to 0.05, I2 = 45%; P = .45) and hypotension (RD, 0.01, 95% CI −0.01 to 0.03, I2 = 0%; P = .57) between 2 groups.Conclusion:Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

Dai

Tang

2018

Medicine

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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, nonindexed 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, , 87, 97, 109, 111, 115, 121] and 32 used ropivacaine[36,38,39,49,52,53,56,60,67,74,75,80,81,84,88,92,95,96,102,105,107,108,110,113,114,119,120,123,[127][128][129][130][131].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, …”

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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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The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Cited by 7 publications

References 16 publications

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block

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

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

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