Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery : A Double-Blinded Randomized Placebo-Controlled Study
Copyright © 2021, Author(s)..
BACKGROUND: Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries.
OBJECTIVES: The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting.
METHODS: In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured.
RESULTS: The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573).
CONCLUSIONS: There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Anesthesiology and pain medicine - 11(2021), 3 vom: 17. Juni, Seite e117020 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Margulis, Roman [VerfasserIn] |
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| Links: |
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| Themen: |
Ambulatory Shoulder Surgeries |
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| Anmerkungen: |
Date Revised 03.04.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.5812/aapm.117020 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM330825429 |
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| 100 | 1 | |a Margulis, Roman |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery |b A Double-Blinded Randomized Placebo-Controlled Study |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 03.04.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2021, Author(s). | ||
| 520 | |a BACKGROUND: Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries | ||
| 520 | |a OBJECTIVES: The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting | ||
| 520 | |a METHODS: In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured | ||
| 520 | |a RESULTS: The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573) | ||
| 520 | |a CONCLUSIONS: There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Ambulatory Shoulder Surgeries | |
| 650 | 4 | |a Arthroscopic Orthopedic Procedures | |
| 650 | 4 | |a Dexamethasone | |
| 650 | 4 | |a Dexmedetomidine | |
| 650 | 4 | |a Interscalene Brachial Plexus Block | |
| 650 | 4 | |a Pain Management | |
| 700 | 1 | |a Francis, Jacquelyn |e verfasserin |4 aut | |
| 700 | 1 | |a Tischenkel, Bryan |e verfasserin |4 aut | |
| 700 | 1 | |a Bromberg, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a Pedulla, Domenic |e verfasserin |4 aut | |
| 700 | 1 | |a Grtisenko, Karina |e verfasserin |4 aut | |
| 700 | 1 | |a Cornett, Elyse M |e verfasserin |4 aut | |
| 700 | 1 | |a Kaye, Alan D |e verfasserin |4 aut | |
| 700 | 1 | |a Imani, Farnad |e verfasserin |4 aut | |
| 700 | 1 | |a Imani, Farsad |e verfasserin |4 aut | |
| 700 | 1 | |a Shaparin, Naum |e verfasserin |4 aut | |
| 700 | 1 | |a Vydyanathan, Amaresh |e verfasserin |4 aut | |
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