Key result
Dexmedetomidine combined with ropivacaine significantly shortened the onset time of brachial plexus block (7.99 vs 15.38 minutes) and prolonged analgesia duration compared to ropivacaine alone in children undergoing upper limb surgery.
Why the study?
The effect of dexmedetomidine combined with ropivacaine on inflammatory factors in children receiving axillary brachial plexus block needed investigation.
Does dexmedetomidine combined with ropivacaine improve analgesia and reduce inflammatory factors compared to ropivacaine alone in children undergoing upper limb surgery with axillary brachial plexus block?
RCT (n=90)
No
Does dexmedetomidine combined with ropivacaine improve analgesia and reduce inflammatory factors compared to ropivacaine alone in children undergoing upper limb surgery with axillary brachial plexus block?
Absolute Event Rate: 7.99% vs 15.38%
p-value: p=< 0.001
Adding dexmedetomidine to ropivacaine for axillary brachial plexus block in children accelerates block onset, prolongs analgesia, and attenuates the postoperative inflammatory response with fewer adverse effects.
Should not yet alter pediatric regional anesthesia; hypothesis-generating for anti-inflammatory adjunct effects in small Level 5 data.
This study aimed to investigate the effect of dexmedetomidine combined with ropivacaine on inflammatory factors in children with axillary brachial plexus block. Ninety patients who underwent upper limb surgery in our hospital from January 2017 to December 2018 were enrolled and divided into groups A and B. Group A (n=40) was treated with ropivacaine as a local anesthetic, and group B (n= 50) was treated with dexmedetomidine combined with ropivacaine as a local anesthetic during surgery. Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale was employed to evaluate the pain behavior of the children. Intravenous blood (3 ml) was taken before surgery (T0), 30 min (T1) and 3 hours after surgery (T2) respectively to detect serum TNF-α (tumor necrosis factor-α), IL-6 (interleukin-6) and IL-1β (interleukin-1β) levels using ELISA. The adverse reactions in the two groups were observed, and the MAP (mean arterial pressure) and HR (heart rate) were compared before anesthesia, 30 min and 1 hour after block. The FLACC score of both groups showed a marked upward trend (p< 0.001), with that of group B being significantly lower than group A (p< 0.001). Group B presented a remarkably shorter onset time than group A, and the analgesic time was significantly longer (p< 0.001). The incidence of adverse reactions in group B was significantly lower than that in group A (p< 0.05). MAP and HR dropped significantly 30 min and 1 h after block (p< 0.05). MAP and HR were significantly lower in group B than those in group A 30 min and 60 min after block (p< 0.05). As to serum levels of TNF-α, IL-6, and IL-1β, both groups presented notably increased ones after block (p< 0.05). The application of dexmedetomidine combined with ropivacaine in upper limb surgery has a faster onset time and longer duration than ropivacaine alone, which is of certain clinical effect.
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Yang et al. (2020) conducted an RCT in Children undergoing upper limb surgery (n=90). Dexmedetomidine combined with ropivacaine vs. Ropivacaine alone was evaluated on Onset time of brachial plexus block (minutes) (p=< 0.001). Dexmedetomidine combined with ropivacaine significantly shortened the onset time of brachial plexus block (7.99 vs 15.38 minutes) and prolonged analgesia duration compared to ropivacaine alone in children undergoing upper limb surgery.
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