Skip to main content
Top
Published in:

Open Access 01-12-2023 | Sufentanil | Research

Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patients undergoing arthroscopic shoulder surgery: a randomized controlled clinical trial

Authors: Hengfei Luan, Conghui Hao, Han Li, Xiaobao Zhang, Zhibin Zhao, Pin Zhu

Published in: Trials | Issue 1/2023

Login to get access

Abstract

Background

Dexmedetomidine, a potent and highly selective α2-adrenoreceptor agonist has become a popular adjuvant to local anesthetics. The study was designed to explore the effect of dexmedetomidine added to ropivacaine for interscalene brachial plexus block (IBPB) on postoperative analgesia in patients undergoing arthroscopic shoulder surgery.

Methods

Forty-four adult patients undergoing arthroscopic shoulder surgery were randomly divided into 2 groups. Group R received 0.25% ropivacaine alone, whereas group RD received 0.25% ropivacaine and 0.5 μg/kg dexmedetomidine. A total volume of 15 ml was administered for ultrasound-guided IBPB in both groups. Duration of analgesia, visual analog scale (VAS) pain score, frequency of PCA pressed, first time of PCA pressed, sufentanil consumption, and patient satisfaction with analgesia quality were recorded.

Results

Compared with group R, the duration of analgesia was prolonged (8.25±1.76 vs. 11.55±2.41 h; P<0.05), the VAS pain scores were decreased at 8 and 10 h postoperatively (3 (2–3) vs. 0 (0–0) and 2 (2–3) vs. 0 (0–2.25), respectively; P<0.05), the frequencies of PCA pressed were decreased at 4–8 and 8–12 h time intervals (0 (0–0.25) vs. 0 (0–0) and 5 (1.75–6) vs. 0 (0–2), respectively; P<0.05), the time of first PCA pressed was prolonged (9.27±1.85 vs. 12.98±2.35 h; P<0.05), the total 24h sufentanil consumption was reduced (108.72±15.92 vs. 94.65±12.47 μg; P<0.05 ) and patient satisfaction score was also improved (3 (3–4) vs. 4 (4–5); P<0.05) in group RD.

Conclusion

We concluded that adding 0.5 μg/kg dexmedetomidine to 0.25% ropivacaine for IBPB provided better postoperative analgesia, decreased the sufentanil consumption and improved the patient’s satisfaction in patients undergoing arthroscopic shoulder surgery.
Literature
2.
go back to reference Fontana C, Di Donato A, Di Giacomo G, Costantini A, De Vita A, Lancia F, et al. Postoperative analgesia for arthrosdcopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy. Eur J Anaesthesiol. 2009;26(8):689–93.CrossRefPubMed Fontana C, Di Donato A, Di Giacomo G, Costantini A, De Vita A, Lancia F, et al. Postoperative analgesia for arthrosdcopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy. Eur J Anaesthesiol. 2009;26(8):689–93.CrossRefPubMed
3.
go back to reference Gan J, Tu Q, Miao S, Lei T, Cui X, Yan J, et al. Effects of oxycodone applied for patient-controlled analgesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty: a randomized controlled clinical trial. Aging Clin Exp Res. 2020;2:329–37.CrossRef Gan J, Tu Q, Miao S, Lei T, Cui X, Yan J, et al. Effects of oxycodone applied for patient-controlled analgesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty: a randomized controlled clinical trial. Aging Clin Exp Res. 2020;2:329–37.CrossRef
4.
go back to reference Li Qiongzhen, Yao Haixia, Meiying Xu, Jingxiang Wu. Dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia increases female patients’ global satisfaction degree after thoracoscopic surgery. J Cardiothorac Surg. 2021;16(1):102.CrossRefPubMedPubMedCentral Li Qiongzhen, Yao Haixia, Meiying Xu, Jingxiang Wu. Dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia increases female patients’ global satisfaction degree after thoracoscopic surgery. J Cardiothorac Surg. 2021;16(1):102.CrossRefPubMedPubMedCentral
5.
go back to reference Harbell MW, Kolodzie K, Behrends M, Ma CB, Kinjo S, Yap E, et al. Extraplexus versus intraplexus ultrasound-guided interscalene brachial plexus block for ambulatory arthroscopic shoulder surgery: a randomized controlled trial. PLoS One. 2021;16(2): e0246792.CrossRefPubMedPubMedCentral Harbell MW, Kolodzie K, Behrends M, Ma CB, Kinjo S, Yap E, et al. Extraplexus versus intraplexus ultrasound-guided interscalene brachial plexus block for ambulatory arthroscopic shoulder surgery: a randomized controlled trial. PLoS One. 2021;16(2): e0246792.CrossRefPubMedPubMedCentral
6.
go back to reference Alam AM, Deeba F, Matin A, Ivy R, Begum N. The additive effects of midazolam in sub arachnoid block in elective caesarian section: a randomized control trial. Mymensingh Med J. 2020;29(4):951–5.PubMed Alam AM, Deeba F, Matin A, Ivy R, Begum N. The additive effects of midazolam in sub arachnoid block in elective caesarian section: a randomized control trial. Mymensingh Med J. 2020;29(4):951–5.PubMed
7.
go back to reference Kirksey MA, Haskins SC, Cheng v, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 2015;10(9):e0137312.CrossRefPubMedPubMedCentral Kirksey MA, Haskins SC, Cheng v, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 2015;10(9):e0137312.CrossRefPubMedPubMedCentral
8.
go back to reference Magalhães E, Ladeira LC, Govêia CS, Espíndola BV. Intravenous dexmedetomidine for sedation does not interfere with sensory and motor block duration during spinal anesthesia. Rev Bras Anestesiol. 2006;56(1):1–7.CrossRefPubMed Magalhães E, Ladeira LC, Govêia CS, Espíndola BV. Intravenous dexmedetomidine for sedation does not interfere with sensory and motor block duration during spinal anesthesia. Rev Bras Anestesiol. 2006;56(1):1–7.CrossRefPubMed
9.
go back to reference Zhang P, Liu S, Zhu J, Rao Z, Liu C. Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study. Reg Anesth Pain Med. 2019;8:rapm-2018-100221. Zhang P, Liu S, Zhu J, Rao Z, Liu C. Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study. Reg Anesth Pain Med. 2019;8:rapm-2018-100221.
10.
go back to reference Li J, Wang H, Dong B, Ma J, Wu X. Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits local inflammatory response. Minerva Anestesiol. 2017;83(6):590–7.CrossRefPubMed Li J, Wang H, Dong B, Ma J, Wu X. Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits local inflammatory response. Minerva Anestesiol. 2017;83(6):590–7.CrossRefPubMed
11.
go back to reference Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498–503.CrossRefPubMed Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498–503.CrossRefPubMed
12.
go back to reference Lee JH, Cho SH, Kim SH, Chae WS, Jin HC, Lee JS, et al. Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth. 2011;58(11):1001–6.CrossRefPubMed Lee JH, Cho SH, Kim SH, Chae WS, Jin HC, Lee JS, et al. Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth. 2011;58(11):1001–6.CrossRefPubMed
13.
go back to reference Fredrickson MJ, Abeysekera A, White R. Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade. Reg Anesth Pain Med. 2012;37(5):495–501.CrossRefPubMed Fredrickson MJ, Abeysekera A, White R. Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade. Reg Anesth Pain Med. 2012;37(5):495–501.CrossRefPubMed
14.
go back to reference Kang R, Jeong JS, Chin KJ, Yoo JC, Lee JH, Choi SJ, et al. Superior trunk block provides noninferior analgesia compared with interscalene brachial plexus block in arthroscopic shoulder surgery. Anesthesiology. 2019;131(6):1316–26.CrossRefPubMed Kang R, Jeong JS, Chin KJ, Yoo JC, Lee JH, Choi SJ, et al. Superior trunk block provides noninferior analgesia compared with interscalene brachial plexus block in arthroscopic shoulder surgery. Anesthesiology. 2019;131(6):1316–26.CrossRefPubMed
15.
go back to reference Woo JH, Kim YJ, Kim KC, Kim CH, Jun J. The effect of interscalene block on ipsilateral shoulder pain and pulmonary function in patients undergoing lung lobectomy: a randomized controlled trial. Medicine (Baltimore). 2018;97(24): e11034.CrossRefPubMed Woo JH, Kim YJ, Kim KC, Kim CH, Jun J. The effect of interscalene block on ipsilateral shoulder pain and pulmonary function in patients undergoing lung lobectomy: a randomized controlled trial. Medicine (Baltimore). 2018;97(24): e11034.CrossRefPubMed
16.
go back to reference Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25.CrossRefPubMed Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25.CrossRefPubMed
17.
go back to reference Christiansen CB, Madsen MH, Mølleskov E, Rothe C, Lundstrøm LH, Lange KHW. The effect of ropivacaine concentration on common peroneal nerve block duration using a fixed dose: a randomised, double-blind trial in healthy volunteers. Eur J Anaesthesiol. 2020;37(4):316–22.CrossRefPubMed Christiansen CB, Madsen MH, Mølleskov E, Rothe C, Lundstrøm LH, Lange KHW. The effect of ropivacaine concentration on common peroneal nerve block duration using a fixed dose: a randomised, double-blind trial in healthy volunteers. Eur J Anaesthesiol. 2020;37(4):316–22.CrossRefPubMed
18.
go back to reference Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta Anaesthesiol Scand. 2020;64(2):238–44.CrossRefPubMed Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta Anaesthesiol Scand. 2020;64(2):238–44.CrossRefPubMed
19.
go back to reference Kang R, Jeong JS, Yoo JC, Lee JH, Choi SJ, Gwak MS, Hahm TS, Huh J, Ko JS. Effective dose of intravenous dexmedetomidine to prolong the analgesic duration of interscalene brachial plexus block: a single-center, prospective, double-blind, randomized controlled trial. Reg Anesth Pain Med. 2018;43(5):488–95.PubMed Kang R, Jeong JS, Yoo JC, Lee JH, Choi SJ, Gwak MS, Hahm TS, Huh J, Ko JS. Effective dose of intravenous dexmedetomidine to prolong the analgesic duration of interscalene brachial plexus block: a single-center, prospective, double-blind, randomized controlled trial. Reg Anesth Pain Med. 2018;43(5):488–95.PubMed
20.
go back to reference Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, Patel R, Oh J, Brull R. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triple-masked Placebo-controlled Trial. Anesthesiol. 2016;124(3):683–95.CrossRef Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, Patel R, Oh J, Brull R. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triple-masked Placebo-controlled Trial. Anesthesiol. 2016;124(3):683–95.CrossRef
21.
go back to reference Zhang H, Zhou F, Li C, Kong M, Liu H, Zhang P, et al. Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: an in vivo and in vitro experimental study. PLoS One. 2013;8(2): e55556.CrossRefPubMedPubMedCentral Zhang H, Zhou F, Li C, Kong M, Liu H, Zhang P, et al. Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: an in vivo and in vitro experimental study. PLoS One. 2013;8(2): e55556.CrossRefPubMedPubMedCentral
22.
go back to reference Tufek A, Kaya S, Tokgoz O, Firat U, Evliyaoglu O, Celik F, et al. The protective effect of dexmedetomidine on bupivacaine-induced sciatic nerve inflammation is mediated by mast cells. Clin Invest Med. 2013;36(2):E95-102 (PMID: 23544611).CrossRefPubMed Tufek A, Kaya S, Tokgoz O, Firat U, Evliyaoglu O, Celik F, et al. The protective effect of dexmedetomidine on bupivacaine-induced sciatic nerve inflammation is mediated by mast cells. Clin Invest Med. 2013;36(2):E95-102 (PMID: 23544611).CrossRefPubMed
23.
go back to reference Sharma S, Shrestha A, Koirala M. Effect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block. Kathmandu Univ Med J (KUMJ). 2019;17(67):178–83.PubMed Sharma S, Shrestha A, Koirala M. Effect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block. Kathmandu Univ Med J (KUMJ). 2019;17(67):178–83.PubMed
24.
go back to reference Singh N, Gupta S, Kathuria S. Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2020;36(2):238–43.CrossRefPubMedPubMedCentral Singh N, Gupta S, Kathuria S. Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2020;36(2):238–43.CrossRefPubMedPubMedCentral
25.
go back to reference Yu ZY, Geng J, Li ZQ, Sun YB, Wang SL, Masters J, Wang DX, Guo XY, Li M, Ma D. Dexmedetomidine enhances ropivacaine-induced sciatic nerve injury in diabetic rats. Br J Anaesth. 2019;122(1):141–9.CrossRefPubMed Yu ZY, Geng J, Li ZQ, Sun YB, Wang SL, Masters J, Wang DX, Guo XY, Li M, Ma D. Dexmedetomidine enhances ropivacaine-induced sciatic nerve injury in diabetic rats. Br J Anaesth. 2019;122(1):141–9.CrossRefPubMed
26.
go back to reference Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: a randomized controlled trial. Anesth Analg. 2015;121(6):1655–60.CrossRefPubMed Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: a randomized controlled trial. Anesth Analg. 2015;121(6):1655–60.CrossRefPubMed
27.
go back to reference Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, Gerner P, Brummett CM. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med. 2014;39(1):37–47.CrossRefPubMed Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, Gerner P, Brummett CM. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med. 2014;39(1):37–47.CrossRefPubMed
28.
go back to reference Yoshitomi T, Kohjitani A, Maeda S, et al. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008;107:96–101.CrossRefPubMed Yoshitomi T, Kohjitani A, Maeda S, et al. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008;107:96–101.CrossRefPubMed
29.
go back to reference Brummett CM, Hong EK, Janda AM, et al. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current. Anesthesiology. 2011;115:836–43.CrossRefPubMed Brummett CM, Hong EK, Janda AM, et al. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current. Anesthesiology. 2011;115:836–43.CrossRefPubMed
30.
go back to reference Yang P, Luo Y, Lin L, Zhang H, Liu Y, Li Y. The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial. Int J Surg. 2020;79:196–201.CrossRefPubMed Yang P, Luo Y, Lin L, Zhang H, Liu Y, Li Y. The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial. Int J Surg. 2020;79:196–201.CrossRefPubMed
Metadata
Title
Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patients undergoing arthroscopic shoulder surgery: a randomized controlled clinical trial
Authors
Hengfei Luan
Conghui Hao
Han Li
Xiaobao Zhang
Zhibin Zhao
Pin Zhu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Trials / Issue 1/2023
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-023-07292-2

Other articles of this Issue 1/2023

Trials 1/2023 Go to the issue