Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study
| Author | Roman Margulis | en |
| Author | Jacquelyn Francis | en |
| Author | Bryan Tischenkel | en |
| Author | Adam Bromberg | en |
| Author | Domenic Pedulla | en |
| Author | Karina Grtisenko | en |
| Author | Elyse M. Cornett | en |
| Author | Alan D. Kaye | en |
| Author | Farnad Imani | en |
| Author | Farsad Imani | en |
| Author | Naum Shaparin | en |
| Author | Amaresh Vydyanathan | en |
| Orcid | Roman Margulis [0000-0002-7049-5542] | en |
| Orcid | Elyse M. Cornett [0000-0001-7961-3931] | en |
| Orcid | Alan D. Kaye [0000-0003-2464-0187] | en |
| Orcid | Farnad Imani [0000-0003-0814-0772] | en |
| Orcid | Farsad Imani [0000-0002-2697-1409] | en |
| Orcid | Naum Shaparin [0000-0003-1060-429X] | en |
| Issued Date | 2021-06-30 | en |
| Abstract | 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. | en |
| DOI | https://doi.org/10.5812/aapm.117020 | en |
| Keyword | Dexmedetomidine | en |
| Keyword | Dexamethasone | en |
| Keyword | Interscalene Brachial Plexus Block | en |
| Keyword | Pain Management | en |
| Keyword | Ambulatory Shoulder Surgeries | en |
| Keyword | Arthroscopic Orthopedic Procedures | en |
| Publisher | Brieflands | en |
| Title | Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study | en |
| Type | Research Article | en |
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