Key result
Perineural dexmedetomidine added to ropivacaine significantly prolonged the duration of postoperative analgesia (10.8 vs 6.9 hours) compared to intravenous dexmedetomidine in upper limb surgery.
Why the study?
An ideal adjuvant to prolong the duration of analgesia in supraclavicular brachial plexus block remains to be discovered.
Does perineural dexmedetomidine compared to intravenous dexmedetomidine improve the duration of analgesia and block characteristics when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block?
RCT (n=60)
Simple random sampling using sealed envelope technique
No
Does perineural dexmedetomidine compared to intravenous dexmedetomidine improve the duration of analgesia and block characteristics when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block?
Perineural administration of dexmedetomidine as an adjuvant to ropivacaine provides faster onset, longer duration of analgesia, and better hemodynamic stability compared to intravenous administration in supraclavicular brachial plexus blocks.
Favors perineural over intravenous dexmedetomidine in supraclavicular blocks; reinforces route-specific adjuvant effects in regional anesthesia RCTs.
Background: In supraclavicular brachial plexus block, to prolong the duration of analgesia, many adjuvants have been tried in the past in many studies but an ideal adjuvant remains yet to be discovered. Dexmedetomidine, a selective Alfa-2 adrenergic agonist when added to local anesthetic has been reported to prolong the block duration and post-operative analgesia in various regional blocks. Aims and Objectives: The aims and objectives are to study the onset and duration of sensory and motor blockade, postoperative analgesia, and hemodynamic effects of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block. Materials and Methods: Sixty patients aged between 18 and 60 years, American Society of Anesthesiologists class I and II, of both sexes, scheduled for upper limb surgery under supraclavicular brachial plexus block were randomly allocated into 2 groups. Group-A received 20 mL of 0.5% ropivacaine in brachial plexus block with 1 μg/kg dexmedetomidine as adjuvant perineurally and Group-B received 20 mL 0.5% ropivacaine in brachial plexus block with dexmedetomidine intravenous infusion at 1 μg/kg over 10 min. Intraoperatively non-invasive blood pressure, heart rate, SpO2, and sedation were recorded every 5 min for the first 10 min and every 15 min thereafter till the end. Time of first rescue analgesic, intensity of postoperative pain, and total analgesic required were recorded. Results: Onset of sensory and motor block was faster in Group-A than Group-B. Duration of analgesia was prolonged in Group-A than Group-B. Hemodynamic stability was better maintained in Group-A than Group-B. Sedation was better in Group B. Conclusion: Dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block is more efficacious in providing faster onset of motor and sensory blocks and prolonging duration of postoperative analgesia with better hemodynamic stability.
No takes yet. Share an insight, caveat, or question.
Roy et al. (2024) conducted an RCT in Upper limb surgery (n=60). Perineural dexmedetomidine vs. Intravenous dexmedetomidine (1 µg/kg) was evaluated on Duration of analgesia (time of first analgesic request) (p=0.006). Perineural dexmedetomidine added to ropivacaine significantly prolonged the duration of postoperative analgesia (10.8 vs 6.9 hours) compared to intravenous dexmedetomidine in upper limb surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: