Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study.

Autor:	Margulis R; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA., Francis J; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA., Tischenkel B; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA., Bromberg A; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA., Pedulla D; Albert Einstein College of Medicine, Bronx, NY, USA., Grtisenko K; Albert Einstein College of Medicine, Bronx, NY, USA., Cornett EM; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA., Kaye AD; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA., Imani F; Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran., Imani F; Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran., Shaparin N; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA., Vydyanathan A; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA.
Jazyk:	angličtina
Zdroj:	Anesthesiology and pain medicine [Anesth Pain Med] 2021 Jul 04; Vol. 11 (3), pp. e117020. Date of Electronic Publication: 2021 Jul 04 (Print Publication: 2021).
DOI:	10.5812/aapm.117020
Abstrakt:	Background: Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries. Objectives: The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting. Methods: In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured. Results: The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573). Conclusions: There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated. Competing Interests: Conflict of Interests: The authors have no conflicts of interest to disclose. (Copyright © 2021, Author(s).)
Databáze:	MEDLINE
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