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Intravenous dexmedetomidine as an adjunct to subarachnoid block: A simple effective method of better perioperative efficacy.

ABSTRACT: Dexmedetomidine (D) is a α2 agonist, has anesthetic and analgesic-sparing property. The objective of this study was to evaluate the effect of intravenous (I.V.) dexmedetomidine on the duration of sensory and motor block, postoperative analgesia, the level of sedation and side effect.Sixty patients were randomly divided into two groups of thirty each. Group D received dexmedetomidine infusion @1 mcg/kg over 10 min and then @ 0.6 mcg/kg/h for rest of duration during surgery, Group C (control) received a similar volume of normal saline infusion before spinal anesthesia with 3 ml of bupivacaine 0.5%. Time of onset and regression time for sensory and motor blockade, the maximum upper level of sensory blockade, duration of postoperative analgesia, Ramsay sedation score and hemodynamic parameters were recorded. Intraoperative bradycardia and atropine requirement along with other side effect were also recorded.The duration of sensorimotor block was significantly longer in D Group (341.7 ± 20.8 min for sensory block and 278.0 ± 11.0 min for motor block) as compared to control group (329.5 ± 22.1 min for sensory block and 250.0 ± 14.8 min for motor block), which was statistically significant (P < 0.05). The mean time for two dermatomal regression of sensory blockade was significantly prolonged in dexmedetomidine group (115.5 ± 8.7 min) compared to control group (95.8 ± 11.4) (P < 0.001). Intraoperative Ramsay sedation scores were significantly higher in D Group (mean - 3.4 ± 0.7, range - 2-4) as compared to C Group (mean - 2.9 ± 0.3, range - 2-4) (P < 0.001). 26.7% (8/30) cases had bradycardia that required atropine as compared to control group (2/30), and none of the patients in the dexmedetomidine group had postoperative shivering as compared to 10% in control group (P = 0.056). Statistical analysis was performed with statistical package for the social science version-20 using analysis of variance/Chi-square test/unpaired t-test, and P < 0.05 was considered statistically significant.I.V. dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. Dexmedetomidine provides an excellent sedation during surgery.

SUBMITTER: Kumari R

PROVIDER: S-EPMC5520593 | biostudies-other | 2017 Apr-Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundDespite the growing interest in dexmedetomidine as an adjunct to truncal blocks, little is known about the systemic absorption of dexmedetomidine after these blocks and its role in analgesia and in hemodynamics.ObjectiveWe investigated the pharmacokinetics and pharmacodynamics of dexmedetomidine as an adjunct to transversus abdominis plane (TAP) block in patients undergoing lower abdominal cancer surgery.MethodsTwenty-four adult patients were randomized to receive a bilateral single-injection TAP block before surgery with 20 mL of bupivacaine 0.5% (TAP group, n = 12) or combined with 1 µg/kg dexmedetomidine (TAP-DEX group, n = 12) and diluted with saline to a volume of 40 mL (20 mL on each side). Plasma concentrations of dexmedetomidine and its pharmacokinetics were investigated using non-compartmental methods, postoperative analgesia, hemodynamics, and adverse events (nausea, vomiting, itching, hypotension, bradycardia, and respiratory depression).ResultsDexmedetomidine was detected in the plasma of 11 patients in the TAP-DEX group. The mean dexmedetomidine peak plasma concentration (Cmax) was 0.158 ± 0.085 (range, 0.045-0.31) ng/mL. The median time to reach peak plasma concentration of dexmedetomidine (Tmax) was 15 (15-45) min. From 2 to 8 h postoperatively, visual analog pain scale (VAS) scores at rest and during movement were significantly lower in the TAP-DEX group. Analgesia time was (11.3 ± 3.12 vs 9.0 ± 4.69 h; P = 0.213) and postoperative morphine consumption was (7.4 ± 3.24 vs 11.5 ± 4.46 mg; P = 0.033) in TAP-DEX and TAP groups, respectively. Lower mean heart rate and mean blood pressure were recorded in the TAP-DEX group intraoperatively and 2 h postoperatively (P < 0.05). Except for mild nausea and vomiting, no adverse events were recorded in either group.ConclusionSystemic absorption of dexmedetomidine administered in a TAP block is common. Direct central effects on the locus coeruleus caused by this systemic absorption may play a role in the analgesia and hemodynamic effects produced by TAP-dexmedetomidine in addition to local mechanisms.Trial registrationClinicalTrial.gov (identifier: NCT03328299).

Project description:BackgroundDexmedetomidine has shown potential in pain control in patients undergoing total knee arthroplasty (TKA). However, the combination of nerve block and dexmedetomidine may be a preferred alternative for postoperative analgesia after TKA. The aim of this study was to perform a meta-analysis on existing randomized controlled trials (RCTs) to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA.MethodsA literature survey was conducted in the databases of PubMed, Embase, Cochrane Library, Web of science, and ScienceDirect for the RCTs completed before February 1st, 2020 that met pre-specified inclusion criteria. The primary outcomes included the pain scores, duration of analgesia, opioid consumption within 24 h postoperatively, and the level of patient satisfaction. The secondary outcomes included the motor strength, degree of sedation, postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool.ResultsThe initial literature search yielded 143 studies, out of which seven studies met the inclusion criteria. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA decreased the postoperative pain scores at rest as well as at motion (SMD = - 1.01 [95% CI - 1.29 to - 0.72], p < 0.01; SMD = - 1.01 [- 1.25 to - 0.77], p < 0.01) respectively, decreased the total opioid consumption within 24 h (SMD = - 0.63 [- 0.86 to - 0.40], p < 0.01), prolonged the duration of analgesia (SMD = 0.90 [0.64 to 1.17], p < 0.01), improved motor strength (SMD = 0.23 [0.01 to 0.45], p = 0.04), improved the degree of sedation (SMD = 0.94 [0.70 to 1.18], p < 0.01), and increased the level of patient satisfaction (SMD = 0.88 [0.60 to 1.17], p < 0.01) without increasing nausea and vomiting (RD = - 0.05 [- 0.11 to 0.01], p = 0.14), as well as other complications (RD = - 0.01 [- 0.08 to 0.07], p = 0.89), compared with local anesthetics alone.ConclusionsIt is effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioid consumption, prolong analgesic duration, and increase patient satisfaction without increasing related complications. Based on the quality of evidence, this meta-analysis recommends that dexmedetomidine can be used in a regular treatment regimen and as an adjunct addition to local anesthetics in nerve block for patients undergoing TKA.RegistrationThis meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

Project description:Perioperative anemia frequently occurs in patients undergoing orthopedic surgery. We aimed to evaluate the efficacy of perioperative intravenous iron therapy (IVIT) on transfusion and recovery profiles during orthopedic surgery. We searched PubMed, Embase, Cochrane, and Google Scholar for eligible clinical trials (randomized controlled trials, RCTs; case-control studies, CCSs) in comparing IVIT and no iron therapy, up to September 2018. Primary outcomes were the effects of IVIT on the proportion of patients transfused and units of red blood cells (RBCs) transfused perioperatively. Secondary outcomes were the effects of IVIT on recovery profiles, such as length of hospital stay (LOS), post-operative infection, and mortality. Subgroup analysis was performed based on iron dose (low: ≤ 300 mg, high: > 400 mg), IVIT period (pre-operative, post-operative, perioperative), and study design. We identified 12 clinical trials (4 RCTs with 616 patients and 8 CCSs with 1,253 patients). IVIT significantly reduced the proportion of patients transfused by 31% (RR, 0.69; P = 0.0002), and units of RBCs transfused by 0.34 units/person (MD, -0.34; P = 0.0007). For subgroup analysis by iron dose, low- or high-dose IVIT significantly reduced the proportion of patients transfused (RR, 0.73, P = 0.005; RR, 0.68, P = 0.008), and RBC units transfused (MD, -0.47, P < 0.0001; MD, -0.28, P = 0.04). For subgroup analysis by period, IVIT administered post-operatively significantly reduced the proportion of patients transfused (post-operative: RR, 0.60, P = 0.002; pre-operative: RR, 0.74, P = 0.06) and RBC units transfused (post-operative: MD, -0.44, P <0.00001; pre-operative: MD, -0.29, P = 0.06). For subgroup analysis by study design, IVIT decreased the proportion of patients transfused and RBC units transfused in the group of CCSs, but IVIT in the group of RCTs did not. IVIT significantly shortened LOS by 1.6 days (P = 0.0006) and reduced post-operative infections by 33% (P = 0.01). IVIT did not change mortality. Perioperative IVIT during orthopedic surgery, especially post-operatively, appears to reduce the proportion of patients transfused and units of RBCs transfused, with shorter LOS and decreased infection rate, but no change in mortality rate. These were only found in CCSs and not in RCTs due to the relatively small number of RCTs with low to high risk of bias.

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Intravenous dexmedetomidine as an adjunct to subarachnoid block: A simple effective method of better perioperative efficacy.

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