Analgesic Efficacy Of Dexmedetomidine Research Articles

Analgesic Efficacy of Dexmedetomidine as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective Randomized Study

Background and Aims: The primary aim of this randomized controlled study was to evaluate the effect of the addition of dexmedetomidine to ropivacaine on the onset and duration of sensory and motor blockade and the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Materials and Methods: A total of 100 patients of age 18–55 years, planned for elective upper limb surgeries under supraclavicular brachial plexus block using a nerve stimulator, were randomly allocated into two groups. Group 1 (n = 50) received 30 mL 0.5% ropivacaine and 1 mL normal saline and Group 2 (n = 50) received 30 mL 0.5% ropivacaine and 1 μg/kg of dexmedetomidine. The onset and duration of sensory and motor block, duration of analgesia, and adverse events during the perioperative period were noted. Results: The onset of sensory and motor block in Group 1 (16. 26 ± 2.23 and 21.68 ± 2.90 min) was slower than those in Group 2 (9.12 ± 2.40 and 12.68 ± 2.62 min), (<0.001). The duration of sensory and motor block in Group 1 was significantly shorter than those in Group 2 (P < 0.001). The duration of analgesia in Group 1 (402.80 ± 28.21 min) was shorter than that in Group 2 (981.00 ± 92.26 min; P < 0.001). There was no statistically significant difference between the two groups in the incidence of the side effects, except in the incidence of sedation which is significantly higher in Group 2, (P < 0.001). Conclusion: Dexmedetomidine with ropivacaine for supraclavicular nerve block resulted in earlier onset and prolonged duration of the sensorimotor blockade and provided a longer pain-free postoperative period without significant hemodynamic alterations.

Analgesic Efficacy of Dexmedetomidine as Adjuvant to Levo-Bupivacine in Ultrasound Guided Erector Spinae Plan Block for Modified Radical Mastectomy

Background& aim: There are several advantages to properly managing post-masctetomy pain. With single shot interfascial plane blocks, local anesthetic adjuvants enhance analgesia duration. They improve the analgesic impact of local anesthetics. Dexamethasone, magnesium sulphate and dexmedetomidine, are examples of adjuvants with diverse modes of action. This research examined the analgesic effects of dexmedetomidine in women who had undergone a modified radical mastectomy (MRM). Methods and Patients: The research included forty women with histopathologically confirmed breast cancer. They were all scheduled for MRM and were randomly assigned to one of two groups: those who got levobupivacaine alone (group C) or those who received dexmedetomidine plus levobupivacaine (group D) during ultrasound (US)-guided erector spinae plane block (ESPB). The two groups were compared in terms of their hemodynamics, demographics, time until the first request for analgesia, numeric rating scale (NRS) scores, Richmond Agitation & Sedation scale (RASS) scores and total opioid use. Results: There were no statistically significant differences observed between the two groups in terms of baseline data. The set of participants referred to as group D had a statistically significant reduction in heart rate on many instances. Furthermore, it was discovered that group D had a substantial reduction in postoperative NRS ratings and a heightened degree of recovery from sedation, as shown by the RASS. Furthermore, it was noted that group D had a significantly reduced overall analgesic dose (9.12±0.46 vs. 6.24±1.37 mg; p= 0.02) and a prolonged duration until first analgesia (6.21±1.28 vs. 7.13±1.79 hours; p< 0.001). Conclusion: The use of dexmedetomidine in combination with levobupivacaine ESPB has been shown to enhance postoperative analgesia compared to the use of levobupivacaine alone. This improvement in postoperative analgesia leads to enhanced comfort levels for patients. Further research is necessary to corroborate these results via future studies conducted in several places.

Analgesic Efficacy of Dexmedetomidine as an Adjunct in Ultrasound-Guided Supraclavicular Block for Pediatric Upper Limb Surgeries: A Randomised Double Blind Controlled Study

Analgesic Efficacy of Dexmedetomidine as an Adjunct in Ultrasound-Guided Supraclavicular Block for Pediatric Upper Limb Surgeries: A Randomised Double Blind Controlled Study

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objectives: Ultrasound-guided supraclavicular brachial plexus block is the most commonly performed approach for the upper limb surgeries and perioperative pain relief. This study was conducted to compare the post-operative analgesic efficacy of dexmedetomidine and clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a prospective, randomized, and double-blinded comparative research that included 60 ASA PS I and II patients who were scheduled for the upper limb surgery. The patients were randomized into two groups, namely, Group C and Group D, with 30 patients each. The patients in Group D were given USG-guided supraclavicular brachial plexus block with 30 ml of 0.5% ropivacaine and dexmedetomidine 1 μg/kg and patients in Group C received 30 ml of 0.5% ropivacaine and clonidine 1 μg/kg. The patients were monitored for post-operative and interpreted by visual analog score and duration of analgesia. The Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever is appropriate, was applied for comparing categorical variables. Results: The mean duration of analgesia was longer and the mean consumption of rescue analgesics was lower in Group D as compared to Group C. No significant post-operative complications or local side effects related to the block were noted. Conclusion: Dexmedetomidine prolongs the duration of sensory and motor block as well as the duration of post-operative analgesia as compared to clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

Postoperative evaluation of analgesia promoted by the use of dexmedetomidine alone and associated with morphine as an intramuscular pre-anesthetic medication in bitches submitted for ovariohysterectomy

Abstract This study aimed to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and when associated with morphine in patients under general inhalational anesthesia with isoflurane and undergoing elective ovariohysterectomy (OH). Twenty healthy bitches were selected via physical and laboratory examinations. Prior to the study, they underwent a 24-h period of adaptation to the environment and observers. They were then randomly divided into two groups: the dexmedetomidine group receiving a dose of 10 μg/kg, and dexmedetomidine group (10 μg/kg) associated with morphine receiving a dose of 0.3 mg/kg, administered via the intramuscular route. Thereafter, patients were induced with propofol and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer. To verify postoperative analgesia, pain assessments were performed using the modified Glasgow (EGM) and Melbourne (EM) scales. For sedation assessment, the Dobbins scale was used at different times: before the administration of pre-anesthetic medication (T0) and at another six times in the postoperative period, 1 (T1), 2 (T2), 4 (T3), 8 (T4), 12 (T5), and 24 (T6) h after orotracheal extubation. No statistical differences were observed between groups in the scales according to Dunn’s Kruskal-Wallis post hoc test, and between the times a statistical difference was noticed by the Friedman test (p<0.05) for the EGM and EM scale scores, but there was no need for analgesic rescue. Therefore, we found that isolated dexmedetomidine and morphine produced adequate analgesic effects in the postoperative period of bitches submitted for OH.

English

English

Evaluation of Postoperative Analgesia of DexmedetomidineAlone or Associated to Morphineas Premedicants in Bitches Undergoing Ovariosalpingohisterectomy

Background:Elective ovariossalpingohysterectomy is a common surgery that causes mild to moderate pain. Aiming at the treatment of pain in these patients, analgesia should be balanced from pre-anesthetic, transoperative and postoperative medication, with α-2-agonists and opioids being commonly used, especially dexmedetomidine that has sedation, relaxation muscle and analgesia. The aim of the present study was to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and associated with morphine when used in the preanesthetic medication of bitches submitted to elective ovarian oysterectomy using the modified Glasgow pain scale and the Melbourne pain scale.Materials,Methods & Results:Twenty bitches were used in this study, all of them submitted to ovarian oysterectomy, and were clinically healthy according to laboratory and clinical exams. During the experiment, bitches were randomly distributed into two groups, which received preanesthetic medication (MPA) with 5μg/kg dexmedetomidine alone (GD) or associated with 0.3 mg/kg morphine (GDM) intramuscularly (IM). In both groups, anesthetic induction with dose-effect propofol was performed and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weight of the animal and maintained on spontaneous ventilation. After stabilization of the patient the surgery was started, which lasted 45 min. The bitches were evaluated by the Modified Glasgow Scale (GSM), the Melbourne Scale (MS) and the Dobbins Sedation Scale (DS), previously administered MPA (T0) and the others performed in 1h (T1), 2h (T2), 4h (T3), 8h (T4), 12h (T5) and 24h (T6) after extubation. If the GSM score was greater than the value of 3.3 an analgesic rescue of 0.5 mg/kg of morphine intramuscularly would be administered. An increase in the scoring of pain scales in both groups can be observed from the T1, with significant difference only of the T1 in relation to the T0 in the GSM of the GDM. Two rescues were performed in T1 of GD and three rescues in T1 and a rescue in T3 of GDM. There was no significant difference between the groups in relation to this variable, as a result of P = 0.62.Discussion:Based on the results of this study, dexmedetomidinedoes not have adequate analgesic effect for use in preemptive analgesia of bitches submitted to elective OSH due to the high number of analgesic rescues. A small increase in GSM and MS scores from T1 can be expected compared to values prior to the surgical procedure since there was no nociceptive stimulation. This increase was only significant in T1 of GDM, moment of greatest rescue number (n = 3). The absence of significant difference between the groups proves that the analgesic effect of dexmedetomidine was not potentiated by the association with morphine at the dose and route used in this experiment. Although morphine is widely used and proven to be effective for the surgical procedure of ovariossalpingohysterectomy, both when used alone and in combination with other drugs, this fact has not been proven in the present study. This fact may have occurred due to the low dose of dexmedetomidine used or due to its short duration. Therefore, dexmedetomidine at the dose used as preanesthetic medication did not produce an adequate analgesic effect in the postoperative period of bitches submitted to elective ovariossalpingohysterectomy. The effects of the same were not potentiated by the association with morphine, at the dose used. Not being recommended for postoperative analgesic control of electiveovariossalpingohysterectomy in bitches. However, further studies are needed to better evaluate the analgesic effect of this α-2-agonist.

Efficacy of dexmedetomidine applied with ropivacaine for thoracic paravertebral blockade in thoracotomy

Objective To explore the analgesic efficacy of dexmedetomidine(Dex) applied with ropivacaine for thoracic paravertebral nerve blockade(TPVB) in thoracotomy. Methods Thirty patients undergoing thoracotomy were randomly divided into two groups(15 patients in each). Patients in one group (group TL) received 0.35% ropivacaine 30 ml for TPVB, while the other group ( group TDL) received 1 μg/kg Dex added into 0.35% ropivacaine 30 ml for TPVB. Thoracic paravertebral patient-controlled analgesia(PCA) was carried out up till 36 h after surgery. The tenderness thresholds on 1 day before surgery, and 12, 24, 48 h and 72 h after surgery were recorded. The consumption of general anesthetics(propofol and remifentanil) during the surgery were also recorded. The incidence of side-effects related to analgesia in the first 3 d after surgery were analyzed. Results The tenderness threshold 24 h and 48 h after surgery in group TDL were significantly higher than in group TL (P<0.05) . Additionally, the intraoperative consumption of Propofol[ (251±13) mg/h vs (211±18) mg/h]and remifentanil[ (0.49±0.05) mg/h vs (0.42±0.04) mg/h]were less than that in group TDL(P<0.05). Conclusions Application of Dex with ropivacaine for continuous TPVB in thoracotomy can relieve postoperative pain. Key words: Dexmedetomidine; Ropivacaine; Field block; Thoracic vertebra; Perioperative; Analgesia

Analgesic efficacy of dexmedetomidine used for epidural anesthesia on labor analgesia

Objective: Toinvestigatetheanalgesic effect of dexmedetomidine in epidural anesthesia for labor analgesia. Methods: 150 nulliparous patients were randomly divided into two groups with 75 cases each: ropivacaine group (R) and ropivacaine+dexmedetomidinegroup (R+Y). R group received analgesia with 0.1% ropivacaine and R+Y group received 0.1% ropivacaine and 0.5 μg/ml dexmedetomidine. The background infusion 10 ml/h, bonus 5 ml, lockout time 20 min. Vital signs, VAS of pain, progress of labor, neonatal Apgar score, postpartum haemorrhage amount, side effects and serum level of IL-6 and TNF-α were recorded. Results: Heart rate and mean arterial pressure of two groups were decreased after analgesia, but still in the normal range. The total stage of labor of R group was (608.2 ± 98.4 min) longer than the R+Y group. Two groups of total labor have a significant difference, especially in the first and second labor. The VAS score of the two groups all decreased after analgesia, score of R+Y group was lower than the other. There were no significant differences in the side effects, postpartum haemorrhage amount and neonatal Apgar score between the two groups. The serum level of IL-6 and TNF-α in R+Y group were lower than the R group in childbirth and 24 h after it. Conclusion: Dexmedetomidine used for epidural anesthesia on labor analgesia has high effect and safety. It can promote the progress of labor without severe side effects. Combination of ropivacaine +dexmedetomidine is better medicine mode for labor analgesia.

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature.

Pain intensity after craniotomy is considered to be moderate to severe during the first 2 postoperative days. The ideal pain treatment to facilitate a rapid postoperative recovery and optimize outcome is unknown. This systematic review aims to report current clinical evidence related to pharmacological and adjuvant analgesic modalities for postcraniotomy pain control. Systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (January 2011 to April 2016). Original research involving the use of any analgesic drug, analgesic method, or nonpharmacological intervention for postcraniotomy pain relief, as assessed by pain scores up to 48 hours postoperatively, supplemental analgesic requirements, or occurence of adverse events. Nineteen RCTs enrolling a total of 1,805 patients were included. Most of the retrieved studies were of moderate-to-good methodological quality. Systemic pharmacological intervention was assessed in 14 RCTs. Opioids (5 RCTs) provided superior pain relief to other analgesics with no significant side effects, but the quality of studies was low. Diclofenac (3 RCTs) presented adequate craniotomy pain control without any adverse effects, while the use of parecoxib is not supported. Dexmedetomidine (3 RCTs) provided adequate transitional analgesia, but further research is needed. Data on the analgesic efficacy of gabapentin, pregabalin, and intravenous lidocaine are very limited (1 RCT for each). Scalp infiltration/block (3 RCTs) provided adequate analgesia in the early postoperative period, while more studies are needed to verify the analgesic benefit obtained from nonpharmacological interventions, such as multipoint electro-acupuncture, in craniotomy surgery (2 RCTs). No definite recommendations can be made based on this systematic review of pharamacological interventions following craniotomy due to significant divergence in the methodology of available studies. Limited evidence on scalp infiltration/block suggests an adequate analgesic effect in the early postoperative period. Analgesic efficacy of dexmedetomidine and multipoint electro-acupuncture needs further evaluation.

The Analgesic Efficacy of Dexmedetomidine as an Adjunct to Local Anesthetics in Supraclavicular Brachial Plexus Block

(Abstracted from Anesth Analg, 121:1655–1660, 2015) Dexmedetomidine is a selective α2-adrenoceptor agonist and has been reported to be safe and effective as an analgesic when administered with peripheral nerve blocks. However, few data are available on the use of dexmedetomidine in brachial plexus blocks.

The Analgesic Efficacy of Dexmedetomidine as an Adjunct to Local Anesthetics in Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial.

This study was designed to assess the effects of dexmedetomidine on the onset and duration of block and postoperative analgesia during supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Sixty adult patients undergoing upper limb and hand surgeries were randomly allocated into 2 groups. The control group received equal volumes of 0.75% ropivacaine and 2% lidocaine with adrenaline, whereas the dexmedetomidine (dexmed) group received 1 μg/kg dexmedetomidine along with equal volumes of 0.75% ropivacaine and 2% lidocaine with adrenaline. A total volume of 0.5 mL/kg was administered in ultrasound-guided supraclavicular brachial plexus block in both groups. Patients were observed for hemodynamic stability, onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects. The onset time of motor blockade was shortened and the duration of sensory, as well as motor, block was significantly prolonged in the dexmed group (P < 0.0001). The duration of postoperative analgesia was also longer in the dexmed group compared with the control group (median [interquartile range], 12 [10.5-13.5] hours and 17 [10.5-19.5] hours in control and dexmed group, respectively [95% confidence interval, -5 {-5, -4}, P < 0.0001]). The requirement for rescue analgesic during the 24-hour postoperative period was less in the dexmed group (P < 0.0001). Postoperative pain scores were comparable among groups except at 8 and 10 hours, when pain scores were lower in the dexmed group. Patients receiving dexmedetomidine were more sedated for 2 hours than the control group patients (P < 0.0001). No episode of bradycardia, hypotension, respiratory depression, or dizziness was reported. We conclude that the addition of dexmedetomidine to ropivacaine-lidocaine prolonged the duration of supraclavicular brachial plexus block and improved postoperative analgesia without significant adverse effects in patients undergoing upper limb surgeries.

Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery

Abstract Study Objectives To determine the analgesic efficacy of dexmedetomidine in the early postoperative period. Design Randomized, double-blind, double placebo-controlled clinical trial. Setting University medical center. Patients 30 ASA physical status I, II, and III patients with cruciate ligament lesion and joint fibrosis who were scheduled for knee arthroscopy. Interventions Patients were prospectively randomized to receive dexmedetomidine one mcg/kg −1 intravenously (IV), for 10 minutes followed by dexmedetomidine 0.3 mcg/kg −1 for 50 minutes or propacetamol two g, IV, for 10 minutes. Measurements Pain scores, time to onset analgesia, and morphine consumption were measured. Open-label rescue morphine 5 mg IV was available as needed during the postdosing evaluation period of 8 hours. Hemodynamic data, sedation scores, and renal and hepatic function were assessed for control of adverse events. Main Results Pain scores with dexmedetomidine and propacetamol were similar. There were no differences in the number of patients who required supplemental rescue analgesia (7/15 vs 4/15; P = 0.44), but total morphine requirements were higher with dexmedetomidine (45 mg) versus propacetamol (20 mg) in the 8-hour follow-up ( P Conclusions Dexmedetomidine provides a modest analgesic effect after knee arthroscopy, but the side effects of this drug, such as hypertension and bradycardia, may restrict the use of large bolus doses.

The analgesic action of dexmedetomidine — a novel α2-adrenoceptor agonist — in healthy volunteers

The analgesic efficacy of dexmedetomidine (DEX) — a novel α 2-adrenoceptor agonist — was studied in man. Single intravenous doses of fentanyl (FEN; 2 μg/kg), DEX (0.25, 0.50 and 1.0μg/kg) and placebo were administered to 5 healthy male volunteers in a double-blind, crossover study in randomized order. The analgesic effect of the different treatments was measured by determining the time course of pain threshold with dental dolorimetry and by quantitating subjective pain induced by a standard ischemic pain stimulus on the upper arm using a visual analogue scale (VAS). The drugs were generally well tolerated. FEN and DEX both had analgesic effects on ischemic pain, which was seen as a statistically significant decrease in subjective VAS ratings. FEN appeared to be more effective than DEX; the difference was not, however, statistically significant. Neither of the drugs affected the pain threshold measurements.