Group BD Research Articles

Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain

Background: in neuroaxial anesthesia, there was many adjuvants used with the purpose of increasing anesthesia duration and reduction of postoperative analgesia.Objective: comparison between dexmedetomidine and fentanyl when added to 0.5% hyperbaric bupivacaine, for lower limb amputation on early stump and phantom pain after spinal anaesthesia.Patients and Methods: Ninety patient arranged for lower limb amputation surgery were randomly allocated into three groups (each 30 patients). Each patient received 2 ml of hyperbaric bupivacaine (0.5%) plus 0.5 ml normal saline in control group (Group B) or 5µ dexmedetomidine diluted in 0.5 ml normal saline in BD group or 25 µ fentanyl diluted in 0.5 ml normal saline in BF group. Anesthesia, analgesia, sedation, hemodynamic changes, adverse effects and post-operative pain up to one month were recorded.Results: The studied groups showed no significant differences regarding demographic characteristics and hemodynamic (heart rate and mean arterial pressure). Patients in group BD had significant increase of sensory and motor block time compared to BF B groups. Post-operatively, there was a significant decrease of pain in BD group in the first 24 hours when compared to control or BF group. The postoperative mean total consumption of analgesics during the first day was significantly decreased in BD when compared to BF and control groups.Conclusions: dexmedetomidine (5μg) represents a good alternative to fentanyl (25μg) as a spinal adjuvant to bupivacaine in surgery for the lower limb.

Effect of Adding Dexmedetomidine to Bupivacaine in Ultrasound Guided Rectus Sheath Block: A Randomized Controlled Double-blinded Study

Background: Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal. Objective: The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision. Methods: Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia. Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used. Results: A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.

The effect of different desensitizing strategies on eroded dentin: ex vivo study

Introduction: Conditions like gastroesophageal reflux disease, eating disorders, chronic alcoholism and others promote the contact of gastric acid (HCl) with the oral cavity, resulting in dental erosive lesions [1]. Study hypothesis: there are no differences on the microscopic aspect of eroded superficial and deep dentin after using two different desensitizing toothpastes. The aim of this study is to evaluate microscopic characteristics of eroded superficial and deep dentin when exposed to desensitizing toothpastes. Materials and methods: Sample was obtained from 2 human molars (intact, caries/fracture-free). Each tooth was sectioned in eight parts (4-superficial dentin and 4-deep dentin), giving rise to 16 dentin specimens, randomly assigned in 4 different groups which were divided into 2 subgroups (superficial (s), n = 2 and deep (d), n = 2): Group As and Ad – sound dentin; Group Bs and Bd – Intrinsic erosive challenge (ec) with HCl at pH 2,6 for 60s; Group Cs and Cd – ec and toothbrush, two minutes, twice a day, seven days with stannous fluoride toothpaste; Group Ds and Dd – ec and toothbrush, two minutes, twice a day, seven days with strontium chloride toothpaste. Dentin surface was analyzed with scanning electron microscopy, with magnifications of 1000×, 5000× and 10000×. The study was approved by the Ethics Committee for Health, of Egas Moniz (Reference Number: 523). Results: On superficial dentin: partial and heterogeneous occlusion of the tubules was observed in group Ds; in group Cs there was no tubule occlusion. On deep dentin samples, partial tubule occlusion was observed in groups Cd and Dd, higher on group Dd. Discussion and conclusions: Qualitative analysis of scanning electron microscopy images suggests that Strontium Chloride based toothpastes are capable of promoting a greater dentinal tubule occlusion. The use of Stannous Fluoride toothpaste showed less favorable results, with tubule occlusion occurring only on deep dentin. Figure 1.

Adição de dexmedetomidina à bupivacaína em bloqueio paravertebral guiado por ultrassom potencializa o alívio da dor pós‐operatória em pacientes submetidos à toracotomia

Background and objectiveThoracic paravertebral blockade is an alternative regional technique for comforting post‐thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography‐guided paravertebral blockade. Material and method93 ASA I–II patients aged 18–65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20mL 0.5% bupivacaine injection in Group B (n=31) and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) injection in Group BD. Group C received postoperative i.v. morphine via patient‐controlled analgesia without paravertebral blockade. Post‐operative pain scores were recorded in the recovery room and post‐operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. ResultsNo significant difference was determined between Group B and Group C regarding intra‐operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p=0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p<0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p<0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p<0.05). ConclusionThe addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

Dexmedetomidine with 0.375% bupivacaine for prolongation of postoperative analgesia in supraclavicular brachial plexus block

Background: Regional anesthesia is the recommended technique for upper-limb surgeries with better postoperative profile. Various agents have been used as adjuvants to prolong the duration of action and improve the efficacy of local anesthetic agents, α2-agonists being the most recent ones. We evaluated the effect of dexmedetomidine with bupivacaine for prolongation of the duration of analgesia in supraclavicular brachial plexus block. Materials and Methods: After Institutional Ethics and Scientific Committee approval and written informed consent, this prospective, observational study was carried out on 64 ASA Grade I and II patients of either sex, aged 18–60 years who underwent upper-limb surgery under brachial plexus block. Patients received either bupivacaine or bupivacaine with dexmedetomidine and were randomly divided into two groups. The primary outcome was duration of analgesia, and the secondary outcome was onset and duration of sensory and motor blockade, Ramsay sedation score, and side effects, if any observed at scheduled intervals. Results: Duration of analgesia in Group B was 391.46 ± 30.66 min and in Group BD was 810 ± 39.52 min (P < 0.0001), onset of sensory block in Group B was 7.9 ± 1.33 min and in Group BD was 5.65 ± 0.68 min (P < 0.0001), onset of motor block in Group B was 15.65 ± 1.66 min and in Group BD was 8.93 ± 0.788 min (P < 0.0001), duration of sensory block in Group B was 236.43 ± 17.52 min and in Group BD was 479.68 ± 40.50 min (P < 0.0001), duration of motor block in Group B was 206.09 ± 24.26 min and in Group BD was 447.81 ± 41.88 min, and slightly higher Ramsay sedation score was seen in Group BD as compared to Group B. The side effects were found to be insignificant and incidental. Only two cases of bradycardia(6.25%) and one case(3.12%) of hypotension were noticed in group BD. Conclusion: Addition of dexmedetomidine to bupivacaine was associated with prolonged analgesia, prolonged sensory and motor blockades with mild sedation.

Magnesium sulfate versus dexmedetomidine as adjuvants to bupivacaine in postoperative epidural analgesia after total knee replacement

Objective The purpose of this study was to evaluate magnesium sulfate (MgSO4) or dexmedetomidine combined with bupivacaine versus bupivacaine for postoperative epidural analgesia in patients undergoing total knee replacement (TKR). Background Epidural analgesia after TKR is an effective widely used technique. Plain bupivacaine is one of the commonly used drugs. Several adjuvants are emerging to enhance its analgesic properties and decrease possible side effects. MgSO4 and dexmedetomidine are promising. Patients and methods This prospective randomized controlled study included 60 patients undergoing TKR who were randomized into three groups for postoperative epidural analgesia: group B bupivacaine, group BM bupivacaine plus MgSO4, and group BD bupivacaine plus dexmedetomidine. Patients received first dose in the postanesthetic care unit and top-up doses were administered if patients had visual analog score greater than 4. The three groups were compared as regards analgesic efficacy, hemodynamic stability, and possible complications. Results No statistically significant difference was found between the three groups as regards patient demographics (age, sex, and the American Society of Anesthesiologists score). Group BD showed superior analgesic criteria with onset at 8.25 ± 1.1 min versus 9.8 ± 1.5 min in group BM and 10.1 ± 1.3 min in group B (P = 0.0002). Earliest peak analgesic effect was noticed in group BD at 14.5 ± 1.2 min versus 16.5 ± 1.6 min in group BM and 16.3 ± 1.5 min in group B (P = 0.0003). Time to top-up dose was longest in group BD (230.4 ± 26.7 min) versus 283.6 ± 32.5 min in group BM and 362 ± 50.1 min in group B (P = 0.0001). Patients in the three groups were hemodynamically stable, apart from four patients in group BM who developed hypotension requiring support (P = 0.01). Conclusion Dexmedetomidine and MgSO4 are safe adjuvants to bupivacaine in post-TKR epidural analgesia. Dexmedetomidine has superior analgesic characters and hemodynamic stability.

A Prospective Study of Comparison of Analgesic Efficacy of Dexamethasone as an Adjuvant in Supraclavicular Block with Intravenous Dexamethasone after Supraclavicular Block in Patients Undergoing Forearm Surgeries.

Context:Brachial plexus block is a preferred anesthesia technique for upper limb surgeries below the shoulder joint. Drugs used as adjuvants in block enhance the postoperative analgesia significantly.Aim:We aimed to evaluate the analgesic efficacy, of perineural dexamethasone used as an adjuvant to supraclavicular block as against systemic dexamethasone after supraclavicular block. Time for rescue analgesia was also noted in both groups.Subjects and Methods:In our randomized study, 60 patients belonging to the American Society of Anesthesiologist physical status Classes I and II were randomly allocated in two groups of thirty. Group BD received supraclavicular block with local anesthetic and dexamethasone 0.05 mg/kg as an adjuvant. Group BI received supraclavicular block with local anesthetic and intravenous (IV) dexamethasone 0.05 mg/kg after the block. In both groups, the comparison of postoperative analgesia and time for first rescue analgesic was noted.Statistical Analysis Used:Data analysis was done using SPSS version 20.0. Demographic data and continuous variables were analyzed by independent sample t-test. Categorical data were analyzed by unpaired t-test.Results:Group BD showed significantly prolonged postoperative analgesia as compared to Group BI. Time for rescue analgesic in Group BD was (15.8 ± 2.6) H as compared to Group BI (10.3 ± 1.07) H.Conclusions:Dexamethasone, when used in supraclavicular block significantly, prolongs the duration of analgesia as against IV dexamethasone after supraclavicular block.

Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy

Background and objectiveThoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method93 ASA I–II patients aged 18–65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20mL 0.5% bupivacaine injection in Group B (n=31) and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. ResultsNo significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p=0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p<0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p<0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p<0.05). ConclusionThe addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

The impact of intravenous dexamethasone on the efficacy and duration of analgesia of paravertebral block in breast cancer surgery: a randomized controlled trial.

PurposeThe study aimed at the evaluation of the impact of intravenous (IV) dexamethasone on efficacy and duration of analgesia of paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM).Patients and methodsThis randomized, double-blind controlled trial included 50 patients with breast cancer scheduled for unilateral MRM. Ultrasound-guided PVB was performed in out-of-plane technique. The technique was repeated at each segment from C7 to T6. The participants were randomly allocated to one of two groups. Group BD (n=25) received IV 8 mg dexamethasone diluted with 8 mL of normal saline to reach 10 mL solution, while Group B received IV 10 mL normal saline. Top-up local infiltration analgesia into the surgical field was performed by the surgeon if needed using lidocaine 1% intraoperatively. Propofol infusion of 50–100 µg/kg/min was maintained throughout the surgery. The time to administration of the first postoperative analgesic dose, pain intensity as visual analog scale (VAS) score, number of patients who required rescue morphine analgesia, total morphine consumption, postoperative nausea and vomiting (PONV) impact scale, and the overall satisfaction of patients with pain management were measured.ResultsFifty patients were randomized and analyzed. The time to first rescue analgesic dose was significantly longer in Group DB (P<0.001). The VAS scores were significantly lower in Group DB compared to Group B up to 12 hours postoperatively. Morphine consumption was lower in Group DB compared to Group B. PONV Impact Scale score was significantly higher in Group B.ConclusionSystemic dexamethasone increased the efficacy and duration of the single-shot multilevel PVB in breast cancer surgery.Trial registrationISRCTN registry, study ID: ISRCTN15920148

Complexity in mood disorder diagnosis: fMRI connectivity networks predicted medication-class of response in complex patients.

ObjectiveThis study determined the clinical utility of an fMRI classification algorithm predicting medication‐class of response in patients with challenging mood diagnoses.MethodsNinety‐nine 16–27‐year‐olds underwent resting state fMRI scans in three groups—BD, MDD and healthy controls. A predictive algorithm was trained and cross‐validated on the known‐diagnosis patients using maximally spatially independent components (ICs), constructing a similarity matrix among subjects, partitioning the matrix in kernel space and optimizing support vector machine classifiers and IC combinations. This classifier was also applied to each of 12 new individual patients with unclear mood disorder diagnoses.ResultsClassification within the known‐diagnosis group was approximately 92.4% accurate. The five maximally contributory ICs were identified. Applied to the complicated patients, the algorithm diagnosis was consistent with optimal medication‐class of response to sustained recovery in 11 of 12 cases (i.e., almost 92% accuracy).ConclusionThis classification algorithm performed well for the know‐diagnosis but also predicted medication‐class of response in difficult‐to‐diagnose patients. Further research can enhance this approach and extend these findings to be more clinically accessible.

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

BackgroundSpinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs.MethodsIn this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups. Via intrathecal approach, the patients received 2.5 ml hyperbaric bupivacaine 0.5% plus 5 micrograms dexmedetomidine (BD group), 25 micrograms fentanyl (BF group) or 0.5 ml normal saline (BN group), respectively. Time to reach the complete motor block, the highest sensory level, regression from block, analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups.ResultsThere was no significant difference between the groups regrading time to reach complete motor block, but time to reach the highest sensory level was shorter in group BD than group BF (6.28 ± 1.75 vs. 7.17 ± 1.45, p = 0.03). Group BD had significantly lower mean of NRS 6 h after operation (1.90 ± 0.84 vs. 6.16 ± 1.44 vs. 6.30 ± 1.17, p < 0.001) and longer duration to regress to Bromage 0 (331.60 ± 73.96 vs. 185.56 ± 35.87 vs. 147.03 ± 33.05 min, p < 0.001), to analgesic request (496.63 ± 70.19 vs. 296.33 ± 44.83 vs. 221.83 ± 22.26 min, p < 0.001), to regress two sensory levels (149.00 ± 23.17 vs. 88.90 ± 12.85 vs. 69.33 ± 6.67 min, p < 0.001) and to regress to S1 (560.53 ± 81.86 vs. 329.83 ± 44.10 vs. 241.83 ± 22.26 min, p < 0.001). Serial changes in SBP (p = 0.006), DBP (p = 0.03) and HR (p = 0.002) in group BF were significantly higher than the other two groups. The three groups had comparable side effects.ConclusionsUsing dexmedetomidine as an adjuvant to bupivacaine for spinal anesthesia in lower limb surgeries has longer duration of sensory and motor block and longer postoperative analgesia.Trial registrationIRCT registration number: IRCT2017041010599N15, 24 May 2017.

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study’s aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery.Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed.Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05).Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.Keywords: arthroscopy, dexmedetomidine, intra-articular, postoperative pain

Effects of accelerated human music on learning and memory performance of rats

A total of forty, 7-week-old male rats were exposed to the ‘rodentized’ version (twice as fast as and one octave higher than the original) of Mozart’s Sonata for Two Pianos in D major for ten minutes a day for 10 weeks. One group (10 rats) received the musical stimuli before (‘B’), another during (‘D’) and the third before and during (‘BD’) the memory test, while the ten control (‘C’) animals were kept in silence. The animals’ spatial learning and memory ability was tested in an 8-arm radial maze. Rats exposed to the music showed a significant (7.1%) improvement in task acquisition (Group BD), but it did not practically change in Group D and worsened by 10.5% in Group B. The 2-h working memory significantly improved by 12.1% (BD) while practically did not change in Groups B and D. The reference memory improved by 11.9% in Group BD, but did not change in Group B and D, compared to the Control. The performance of the groups during the 4-h working memory test did not differ significantly. During the long-term test period the spatial memory performance of the music-exposed rats did not show significant differences compared to the Control (Table 1). At the same time, most results obtained in the long-term period were better than the corresponding short-term data. In conclusion, this particular piece of music, falling within the rats’ hearing range, was suitable for improving hippocampus-dependent spatial learning capacity, but only if the animals were exposed to it not only before but also during the task.

Relationship between C-C chemokine receptor type 2 and P38 mitogen-activated protein kinase signaling pathway in the spinal cord of rats with bone cancer pain

Objective: To investigate the relationship between C-C chemokine receptor type 2(CCR2) and P38 mitogen-activated protein kinase (P38MAPK) signaling pathway in the spinal cord of rats and further clarify the mechanism of bone cancer pain (BCP). Methods: A total of 92 healthy female SD rats, of which 60 were subjected to behavioral tests using a ciliary mechanical stimulation needle. SD rats were randomly divided into six groups: sham operation group (group S), bone cancer pain group (group B), sham operation + DMSO solvent group (group SD), bone cancer pain + DMSO solvent group (group BD), sham operation + RS102895 CCR2 inhibitor group (group SR), bone cancer pain + RS102895 CCR2 inhibitor group (group BR), and Von Frey was used in the behavioral test. Another 32 SD rats were randomly divided into the following 8 groups (n=4): sham operation group (group S), bone cancer pain 5 d group (group B5), bone cancer pain 9 d group (group B9), bone cancer pain 14 d group (group B14), bone cancer pain + DMSO solvent group (group BD), bone cancer pain + RS102895 CCR2 inhibitor 0.5 h group (group BR0.5 h), bone cancer pain + RS102895 CCR2 inhibitor 4 h group (group BR4 h), bone cancer pain + RS102895 CCR2 inhibitor 12 h group (group BR12 h). Western blot was used to detect the expression of P38, p-P38 and CCR2 in spinal cord of rats. Results: At day 5, 7, 9, 14, 21 post-injection, mechanical withdrawal thresholds of group S were(30.9±1.5), (31.9±1.2), (32.0±1.1), (31.6±1.5), (32.2±1.4)g respectively, the mechanical withdrawal thresholds of group B were( 26.4±0.7), (24.4±0.8), (21.4±0.8), (13.5±0.4), (9.9±0.2)g respectively, the mechanical withdrawal thresholds in group B decreased obviously versus group S, and the differences were statistically significant(t=-13.177, -16.660, -23.778, -35.574, -48.401, all P<0.01). At day 9 post-injection, the mechanical withdrawal thresholds in SD, BD, SR and BR groups were (32.4±1.7), (19.4±1.1), (32.1±1.3), (26.3±1.0) g respectively, the difference was statistically significant (F=224.681, P<0.01), and the mechanical withdrawal thresholds in group BD decreased obviously versus group SD, while the mechanical withdrawal thresholds in group BR increased obviously versus group BD. The expression levels of p-P38 in spinal cord of group S, group B5, group B9 and group B14 were(0.08±0.03), (0.20±0.05), (0.40±0.17), (0.65±0.14)respectively, the expression levels of CCR2 were(0.08±0.04), (0.18±0.05), (0.30±0.09), (0.58±0.07)respectively, the difference was statistically significant(F=19.123, 40.746, all P<0.01), and the expression of p-P38 and CCR2 in group B9 were showed a significant up-regulation versus group S. The expression levels of p-P38 in spinal cord of group BD, group BR0.5 h, group BR4 h and group BR12 h were (0.57±0.06), (0.17±0.11), (0.03±0.01), (0.25±0.11)respectively, and the difference was statistically significant(F=29.582, P<0.01). The expression of p-P38 in group BR0.5 h, BR4 h, BR12 h showed a significant down-regulation versus group BD. Conclusion: CCR2 in the spinal cord may be involved in the development of bone cancer pain by activating P38MAPK signaling pathway in rats.

Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis plane block ultrasound guided in postoperative pain of abdominal surgery

We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21mL 0.9% saline in Group C (n=31), 20mL 0.5% bupivacaine+1mL saline in Group B (n=31), and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) in Group BD (n=31). Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p<0.05); it was lower in group BD than in group B at 10-24h. In Group B, it was lower than Group C at 2-8h (p<0.05). Total morphine consumption was lower in Group BD compared to other groups and lower in group B than in the controls (p<0.001). Patient satisfaction was higher in Group BD than in other groups and was higher in both study groups than in the controls (p<0.001). Nausea-vomiting scores, antiemetic requirement, or additional analgesic administration were not significant among groups (p>0.05). The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.

Intraperitoneal dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management in children undergoing laparoscopic appendectomy: A prospective randomized trial

Background and Aims:Intraperitoneal local anesthetic is an effective analgesic approach in laparoscopic appendectomy in adults. The aim of the study was to compare the postoperative pain when intraperitoneal bupivacaine is administered alone versus the addition of dexmedetomidine to it in children undergoing a laparoscopic appendectomy.Methods:In this prospective randomized trial, 52 children were randomly allocated to Group B who received intraperitoneal bupivacaine 0.25% (2 mg/kg) or Group BD who received intraperitoneal bupivacaine 0.25% (2 mg/kg) plus dexmedetomidine (1 mcg/kg) for postoperative analgesia in children undergoing laparoscopic appendectomy. Postoperative pethidine consumption at day 1 was recorded and considered the primary outcome of the study. Patients were evaluated for pain scores at 0, 2, 4, 6, 12, and 24 h, time to first request of pethidine, sedation scores at 0, 2, 4, and 6 h, length of hospital stay, and parents’ satisfaction. Chi-square, Fisher's exact, Student's t-test, and Mann–Whitney U-tests were used for analysis.Results:Postoperative visual analog scale scores were lower in Group BD at 2, 4, and 6 h (mean = 3, 3, 3, respectively) compared with Group B (mean = 4, 5, 4, respectively) (P < 0.05). Patients in Group BD had more sedation scores at 0, 2, and 4 h (P < 0.05), longer time to first rescue analgesia (P = 0.03), lesser rescue analgesic consumption (P = 0.02), shorter length of hospital stay (P = 0.02), and higher parents’ satisfaction (P = 0.01).Conclusion:Adding dexmedetomidine to intraperitoneal bupivacaine provides adequate postoperative analgesia in children undergoing laparoscopic appendectomy.

Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study

Background and Aims:General anaesthesia (GA) is the standard technique and paravertebral block (PVB) is suggested as an ideal analgesic in patients undergoing modified radical mastectomy (MRM). This study assessed post-operative analgesic efficacy of morphine or dexmedetomidine as adjuvant to bupivacaine in PVB.Methods:Forty-five women (18–60 years) undergoing MRM ± axillary clearance received PVB with 20 ml bupivacaine 0.25% with morphine 3 mg (Group BM) or dexmedetomidine 1 μg/kg (Group BD) in this prospective, randomised, double-blind study. After confirming the onset of PVB, standardised GA induction sequence was used. Intra-operative consumption of fentanyl and propofol along with postoperative morphine and diclofenac consumption, numerical rating scores (NRS) for pain at rest and on movement, nausea and vomiting scores, sedation scores and time to rescue analgesic were recorded. Chi-square or Fisher's exact test and Kruskal–Wallis followed by Mann–Whitney U-test were applied as applicable.Results:The number of patients requiring morphine during first 2-h post-operatively was significantly lower (P = 0.006) in Group BM. The mean dose of morphine in Group BM (0.84 [2.41] mg) and Group BD (1.70 [1.84] mg) was comparable (P = 0.187). NRS for pain at rest and on movement was significantly lower in Group BM at 2, 6, 12 and 18 h. The duration of analgesia was significantly prolonged in Group BM (1019.8 [422.9] min) than in Group BD (263.7 [194.9] min) (P < 0.001).Conclusion:Morphine is superior adjuvant to bupivacaine in PVB for modified radical mastectomy than dexmedetomidine.

To compare efficacy of bupivacaine and bupivacaine with dexamethasone for supraclavicular brachial plexus block in patients undergoing upper-limb surgeries: A one -year randomized controlled trial

OBJECTIVE: Brachial plexus block is a viable alternative to general anaesthesia as it provides adequate muscle relaxation,excellent intraoperative and post operative analgesia. Dexamethasone ,a synthetic glucocorticoid was combined with local anaesthetics to study the effects . This study was conducted to compare the onset and duration of sensory and motor block following administration of either bupivacaine and bupivacaine- Dexamethasone in patients undergoing upper limb surgeries under USG guided supraclavicular block.MATERIALS AND METHODS: 60 ASA I / II patients between of 18 and 60 years who underwent elective upper limb surgeries randomly allocated into two groups of 30 each by a sealed envelope technique to receive 30 ml of 0.5% Bupivacaine and 2 ml of normal saline in Group BS and 30 ml of 0.5% Bupivacaine with 2ml (8mg) of Dexamethasone in Group BD. The onset duration of sensory and motor blockade were observed between the two groups.RESULTS: The onset of sensory and motor blockade was faster in Group BD when compared to Group BS (p<0.0001). The duration of sensory and motor blockade was longer in Group BD when compared to Group BS (p<0.0001). There were no significant haemodynamic changes in the study group.CONCLUSION: Dexamethasone when added to Bupivacaine in supraclavicular block shortens the onset time and prolongs the duration of sensory and motor blockade without any systemic side effects.

The effects of addition of dexamethasone to bupivacaine during ultrasound-guided femoral nerve block for postoperative analgesia in patients undergoing total knee replacement surgery

IntroductionThe goal of knee replacement is to relieve pain, improve quality of life, and maintain or improve knee function. The procedure is performed on people of all ages. However, a significant number of patients experience persistent pain and functional limitations following knee replacement, with ~20% of patients reporting unfavorable pain outcomes.Materials and methodsOur study was done after obtaining Assiut University Hospital Ethical Committee approval and informed written consent from the patients who were admitted to the Department of Orthopedics in Assiut University Hospital and were planned for total knee replacement surgery in the period from December 2015 until July 2017. Our study included 60 patients aged between 18 and 80 years. Patients were randomized into two groups: group B (30 ml of 0.25% bupivacaine) and group BD (28 ml of 0.25% bupivacaine + 2 ml dexamethasone 8 mg).ResultsThe current study showed that preemptive addition of 8 mg dexamethasone to 30 ml bupivacaine 0.25% for femoral nerve block guided with ultrasound for total knee replacement surgery on side of operation resulted in a reduction of visual analog scale pain score over the postoperative 24 h prolonged the duration of the block, required longer time till first analgesic, and led to more patient satisfaction and less incidence of nausea and vomiting. As seen in our results that the visual analog scale was significantly low starting from 4 h (1 ± 0 vs. 1.13 ± 0.35; P < 0.001), 8 h (1.07 ± 0.25 vs. 1.67 ± 0.71; P < 0.001), 12 h (1.23 ± 0.43 vs. 1.97 ± 0.67; P = 0.789), 16 h (1.67 ± 0.71 vs. 2.37 ± 0.67; P = 0.563), 20 h (1.9 ± 0.76 vs. 2.87 ± 0.82; P = 0.774), and 24 h (2.03 ± 0.76 vs. 2.97 ± 0.61; P = 0.052).ConclusionOur study results demonstrate that the addition of dexamethasone to bupivacaine suggestively prolongs its analgesic effect postoperatively. These results are consistent with the trend of previous studies using dexamethasone as an additive to local anesthetic in peripheral nerve blocking.

Effect of Dexamethasone on Characteristics of Supraclavicular Nerve Block with Bupivacaine and Ropivacaine: A Prospective, Double-blind, Randomized Control Trial.

Background:Dexamethasone as an adjuvant to bupivacaine and ropivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, comparison of effect of dexamethasone (8 mg) when added to these two local anesthetics has not been well studied. This study was conducted to compare analgesic efficacy of dexamethasone as adjuvant to bupivacaine and ropivacaine in SCBP block.Subjects and Methods:Nerve stimulator-guided SCBP block was given to 120 patients, randomly assigned to one of four groups: (n = 30 in each group) Group B, BD, R, and RD received 30 ml (0.5%) bupivacaine + 2 ml saline, 30 ml (0.5%) bupivacaine + dexamethasone 8 mg, 30 ml (0.5%) ropivacaine + 2 ml saline, and 30 ml (0.5%) ropivacaine + dexamethasone 8 mg, respectively. Time for request of the first rescue analgesic, 24-h analgesic consumption, and different block characteristics were assessed. Student's t-test, Chi-square test, ANOVA were used for statistical analysis.Results:Dexamethasone significantly prolonged time for request of the first rescue analgesic of both ropivacaine (1211.83 ± 32.86 vs. 283.17 ± 7.71 min){ p R, RD < 0.001} and bupivacaine (1205.17 ± 34.32 vs. 364.67 ± 16.50 min) {p B, BD < 0.001}. 24-h requirement for rescue analgesics was more in Groups B and R when compared to Groups BD and RD. The increase in duration of analgesia was more when Groups R and RD (928.66 min) were compared than Groups B and BD (840.5 min). Similar results were seen with onset times and duration of sensory and motor block.Conclusion:The addition of dexamethasone to bupivacaine and ropivacaine in SCBP block prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block, with the effect being stronger with ropivacaine.