Effect of axillary perineural dexmedetomidine on hemodynamic changes and postoperative pain in patients undergoing upper limb surgery under general anesthesia: A randomized double-blind study

Document Type : Original Article

Authors

1 Department of Anesthesiology, Kashan University of Medical Sciences, Kashan, Iran

2 Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran

3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

10.4103/atr.atr_11_22

Abstract

Background and Objectives: Perineural dexmedetomidine as an adjuvant of local anesthetics has been used in regional anesthesia to prolong the duration of analgesia. This study aimed to assess the effects of perineural injection of dexmedetomidine alone on the duration of postoperative analgesia, narcotic consumption, and hemodynamic changes in the patients undergoing upper limb surgery under general anesthesia. Methods: Sixty patients undergoing upper limb surgery were randomly allocated into two equal groups. The intervention group received 100 μg dexmedetomidine/20 ml normal saline (NS) as perineural axillary brachial plexus injection, whereas the control group received 20 ml NS injection. Patients were compared for hemodynamic changes, postoperative pain through Visual Analog Scale, consumed narcotics and side effects. Results: The postoperative analgesia in the dexmedetomidine group was significantly longer than the control one. The amount of opioid administered in the control group was significantly more than that amount used in the intervention group. Mean arterial pressure (MAP) and heart rate (HR), in parallel, in the intervention group at 15, 30, 45, and 60 min after induction of anesthesia were significantly decreased in the intervention group than the control group. No dramatic drop in MAP and HR was observed. No significant complication also was reported. Conclusions: Perineural axillary brachial plexus injection of 100 μg dexmedetomidine/20 ml NS prolonged postoperative analgesia and reduced narcotic consumption in patients undergoing upper limb surgery under general anesthesia without noticeable side effects.

Keywords

References

1.
Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 2014;15:4.  Back to cited text no. 1
    
2.
Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (N Y) 2012;7:18-22.  Back to cited text no. 2
    
3.
Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG. Upper extremity nerve block: How can benefit, duration, and safety be improved? An update. F1000Res 2016;5:v1000-907.  Back to cited text no. 3
    
4.
Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg 2012;20:38-47.  Back to cited text no. 4
    
5.
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;121:1655-60.  Back to cited text no. 5
    
6.
Sindjelic RP, Vlajkovic GP, Davidovic LB, Markovic DZ, Markovic MD. The addition of fentanyl to local anesthetics affects the quality and duration of cervical plexus block: A randomized, controlled trial. Anesth Analg 2010;111:234-7.  Back to cited text no. 6
    
7.
White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005;101:S5-22.  Back to cited text no. 7
    
8.
Hussain N, Brummett CM, Brull R, Alghothani Y, Moran K, Sawyer T, et al. Efficacy of perineural versus intravenous dexmedetomidine as a peripheral nerve block adjunct: A systematic review. Reg Anesth Pain Med 2021;46:704-12.  Back to cited text no. 8
    
9.
Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis. Indian J Anaesth 2012;56:542-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Helander EM, Menard BL, Harmon CM, Homra BK, Allain AV, Bordelon GJ, et al. Multimodal analgesia, current concepts, and acute pain considerations. Curr Pain Headache Rep 2017;21:3.  Back to cited text no. 10
    
11.
Niu XY, Ding XB, Guo T, Chen MH, Fu SK, Li Q. Effects of intravenous and intrathecal dexmedetomidine in spinal anesthesia: A meta-analysis. CNS Neurosci Ther 2013;19:897-904.  Back to cited text no. 11
    
12.
Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries. Saudi J Anaesth 2014;8:463-9.  Back to cited text no. 12
    
13.
Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: A volunteer study. Br J Anaesth 2013;110:438-42.  Back to cited text no. 13
    
14.
Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: A systematic review and meta-analysis. Br J Anaesth 2013;110:915-25.  Back to cited text no. 14
    
15.
Panchgar V, Shetti AN, Sunitha HB, Dhulkhed VK, Nadkarni AV. The effectiveness of intravenous dexmedetomidine on perioperative hemodynamics, analgesic requirement, and side effects profile in patients undergoing laparoscopic surgery under general anesthesia. Anesth Essays Res 2017;11:72-7.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010;111:1548-51.  Back to cited text no. 16
    
17.
Brummett CM, Padda AK, Amodeo FS, Welch KB, Lydic R. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology 2009;111:1111-9.  Back to cited text no. 17
    
18.
Helal SM, Eskandr AM, Gaballah KM, Gaarour IS. Effects of perineural administration of dexmedetomidine in combination with bupivacaine in a femoral-sciatic nerve block. Saudi J Anaesth 2016;10:18-24.  Back to cited text no. 18
    
19.
Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015;9:148-54.  Back to cited text no. 19
    
20.
Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2014;30:36-40.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Sane S, Shokouhi S, Golabi P, Rezaeian M, Kazemi Haki B. The effect of dexmedetomidine in combination with bupivacaine on sensory and motor block time and pain score in supraclavicular block. Pain Res Manag 2021;2021:8858312.  Back to cited text no. 21
    
22.
Akhondzadeh R, Rashidi M, Gousheh M, Olapour A, Baniahmad A. The effect of adding dexmedetomidine as an adjuvant to lidocaine in forearm fracture surgeries by supraclavicular block procedure under ultrasound-guided. Anesth Pain Med 2018;8:e74355.  Back to cited text no. 22
    
23.
Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res 2012;2:67-9.  Back to cited text no. 23
    
Archives of Trauma Research
Volume 11, Issue 1
March 2022
Pages 21-25

Files

History

  • Receive Date: 18 June 2023
  • Accept Date: 18 June 2023

Share

How to cite

Statistics