A Comparative Study of the Effect of Adding Dexmedetomidine, Dexamethasone and Sodium Bicarbonate to Ropivacaine in Ultrasound Guided Supraclavicular Block on the Quality of the Block in Orthopedic Surgery
Abstract
Background: Brachial plexus block, particularly the supraclavicular approach. The choice of local anesthetic and the addition of adjuvants can significantly impact the quality and duration of the block. This study aimed to compare the effects of three different additives dexmedetomidine, dexamethasone, and sodium bicarbonate when combined with ropivacaine in ultrasound-guided supraclavicular blocks.
Methods: A double-blind randomized clinical trial was conducted with 103 patients undergoing upper limb orthopedic surgery. Patients were divided into four groups, and each group received one of the following combinations: ropivacaine with dexmedetomidine, ropivacaine with dexamethasone, ropivacaine with sodium bicarbonate, or ropivacaine alone (control). The onset and duration of motor and sensory blocks, complications, patient and surgeon satisfaction, and vital signs were assessed.
Results: The study revealed that all additives, particularly dexmedetomidine, significantly influenced the onset and duration of motor and sensory blocks compared to the control group. Dexmedetomidine demonstrated the fastest onset and prolonged the block, while dexamethasone and sodium bicarbonate also had substantial effects. Importantly, the additives did not lead to an increase in complications, and patient and surgeon satisfaction remained consistent across all groups.
Conclusion: The findings of this study suggest that dexmedetomidine is a promising adjuvant for enhancing the quality and duration of supraclavicular blocks.
[1] Balakrishnaiah M, Sheshadri K, Ramegowda S, Srinivasan R, Ullas Lolakrishna R, T Sambandam M. Comparison Between Dexamethasone Versus Clonidine as Adjuvants to 0.75% Ropivacaine in Ultrasound Guided Brachial Plexus Block for Upper Limb Orthopedic Surgeries: A Randomized Prospective Clinical Study. Arch Anesth & Crit Care. 2023; 10(1):55-59.
[2] Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg. 2012; 20(1):38-47.
[3] Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(41):e12573.
[4] D'Souza RS, Johnson RL. Supraclavicular Block. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519056/
[5] Yu Z, Liu Y, Zhu C. Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning. J Healthc Eng. 2021; 2021:6676610.
[6] Johnson RL, Kopp SL, Kessler J, Gray T. Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia. In Millers Anesthesia 9th ed. 2020; 1461.
[7] Čižmáriková R, Čižmárik J, Valentová J, Habala L, Markuliak M. Chiral Aspects of Local Anesthetics. Molecules. 2020; 25(12):2738.
[8] Lirk P, Picardi S, Hollmann MW. Local anaesthetics: 10 essentials. Eur J Anaesthesiol. 2014; 31(11):575-585.
[9] Bailard NS, Ortiz J, Flores RA. Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations. Am J Health Syst Pharm. 2014; 71(5):373-85.
[10] Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 2011; 49(4):104-16.
[11] Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(4):e5846.
[12] Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013; 3:475–83
[13] Nazemroaya B, Jabalameli M, Kamali A. Assessing the Effects of Dexmedetomidine and Labetalol on Changes in Heart Rate and Blood Pressure after Laryngoscopy Compared to a Control Group. J Cell Mol Anesth. 2020; 5(2):79-83.
[14] Wu HH, Wang HT, Jin JJ, et al. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One. 2014; 9(3):e93114.
[15] Nazemroaya B, Honarmand A, Bab Hadi Ashar M. Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changes in psychiatric patients undergoing electroconvulsive therapy. Koomesh 22 (2), 311-316.
[16] D'Souza RS, Johnson RL. Supraclavicular Block. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK519056/
[17] Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(41):e12573.
[18] Kour L, Sharma G, Tantray SH. Evaluation of Addition of Sodium Bicarbonate to Dexamethasone and Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Orthopedic Procedures. Anesth Essays Res. 2021;15(1):26-31.
[19] Singh V, Pahade A, Mowar A. Comparing Efficacy of Intravenous Dexmedetomidine and Lidocaine on Perioperative Analgesic Consumption in Patients Undergoing Laparoscopic Surgery. Anesth Essays Res. 2022 Jul-Sep;16(3):353-359.
[20] Nestor CC, Ng C, Sepulveda P, Irwin MG. Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review. Anaesthesia. 2022; 77(3):339-350.
[21] Edinoff AN, Fitz-Gerald JS, Holland KAA, Reed JG, Murnane SE, Minter SG, Kaye AJ, Cornett EM, Imani F, Khademi SH, Kaye AM, Urman RD, Kaye AD. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesth Pain Med. 2021; 11(3):e117146.
[22] Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostals blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003; 96: 576–82.
[23] Stan T, Goodman E, Cardida B, Curtis RH. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004; 29: 380–1
[24] Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg. 1998; 87: 913–7.
[25] McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994; 47:28–45.
[26] Tan P, Liu K, Peng CH. Lingcheng Y, Chung-ren L The effect of dexamethasone on postoperative pain and emesis after intrathecal neostigmine. Anesth Analg. 2001; 92: 228–32.
[27] Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006; 102(1):263-7
[28] Marks R, Barlow JW, Funder JW. Steroid-induced vasoconstriction: glucocorticoid antagonist studies. J Clin Endo Meta. 1982; 54: 1075–7.
[29] Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res. 2012; 2:67-69.
[30] Das A, Majumdar S, Halder S, Chattopadhyay S, Pal S, Kundu R, et al.: Effect of dexmedetomidine as adjuvant in ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded and randomized controlled study. Saudi J Anaesth. 2014, 8: S72-7.
[31] Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008; 107(1):96-101.
[32] A N, Sahu L, Das S, Muni M. Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block. Cureus. 2023; 15(5):e38775.
[2] Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg. 2012; 20(1):38-47.
[3] Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(41):e12573.
[4] D'Souza RS, Johnson RL. Supraclavicular Block. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519056/
[5] Yu Z, Liu Y, Zhu C. Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning. J Healthc Eng. 2021; 2021:6676610.
[6] Johnson RL, Kopp SL, Kessler J, Gray T. Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia. In Millers Anesthesia 9th ed. 2020; 1461.
[7] Čižmáriková R, Čižmárik J, Valentová J, Habala L, Markuliak M. Chiral Aspects of Local Anesthetics. Molecules. 2020; 25(12):2738.
[8] Lirk P, Picardi S, Hollmann MW. Local anaesthetics: 10 essentials. Eur J Anaesthesiol. 2014; 31(11):575-585.
[9] Bailard NS, Ortiz J, Flores RA. Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations. Am J Health Syst Pharm. 2014; 71(5):373-85.
[10] Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 2011; 49(4):104-16.
[11] Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(4):e5846.
[12] Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013; 3:475–83
[13] Nazemroaya B, Jabalameli M, Kamali A. Assessing the Effects of Dexmedetomidine and Labetalol on Changes in Heart Rate and Blood Pressure after Laryngoscopy Compared to a Control Group. J Cell Mol Anesth. 2020; 5(2):79-83.
[14] Wu HH, Wang HT, Jin JJ, et al. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One. 2014; 9(3):e93114.
[15] Nazemroaya B, Honarmand A, Bab Hadi Ashar M. Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changes in psychiatric patients undergoing electroconvulsive therapy. Koomesh 22 (2), 311-316.
[16] D'Souza RS, Johnson RL. Supraclavicular Block. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK519056/
[17] Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(41):e12573.
[18] Kour L, Sharma G, Tantray SH. Evaluation of Addition of Sodium Bicarbonate to Dexamethasone and Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Orthopedic Procedures. Anesth Essays Res. 2021;15(1):26-31.
[19] Singh V, Pahade A, Mowar A. Comparing Efficacy of Intravenous Dexmedetomidine and Lidocaine on Perioperative Analgesic Consumption in Patients Undergoing Laparoscopic Surgery. Anesth Essays Res. 2022 Jul-Sep;16(3):353-359.
[20] Nestor CC, Ng C, Sepulveda P, Irwin MG. Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review. Anaesthesia. 2022; 77(3):339-350.
[21] Edinoff AN, Fitz-Gerald JS, Holland KAA, Reed JG, Murnane SE, Minter SG, Kaye AJ, Cornett EM, Imani F, Khademi SH, Kaye AM, Urman RD, Kaye AD. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesth Pain Med. 2021; 11(3):e117146.
[22] Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostals blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003; 96: 576–82.
[23] Stan T, Goodman E, Cardida B, Curtis RH. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004; 29: 380–1
[24] Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg. 1998; 87: 913–7.
[25] McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994; 47:28–45.
[26] Tan P, Liu K, Peng CH. Lingcheng Y, Chung-ren L The effect of dexamethasone on postoperative pain and emesis after intrathecal neostigmine. Anesth Analg. 2001; 92: 228–32.
[27] Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006; 102(1):263-7
[28] Marks R, Barlow JW, Funder JW. Steroid-induced vasoconstriction: glucocorticoid antagonist studies. J Clin Endo Meta. 1982; 54: 1075–7.
[29] Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res. 2012; 2:67-69.
[30] Das A, Majumdar S, Halder S, Chattopadhyay S, Pal S, Kundu R, et al.: Effect of dexmedetomidine as adjuvant in ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded and randomized controlled study. Saudi J Anaesth. 2014, 8: S72-7.
[31] Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008; 107(1):96-101.
[32] A N, Sahu L, Das S, Muni M. Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block. Cureus. 2023; 15(5):e38775.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Supraclavicular block Dexmedetomidine Dexamethasone Sodium bicarbonate Ropivacaine additives | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Golparvar M, Mansoori Borooojeni AA. A Comparative Study of the Effect of Adding Dexmedetomidine, Dexamethasone and Sodium Bicarbonate to Ropivacaine in Ultrasound Guided Supraclavicular Block on the Quality of the Block in Orthopedic Surgery. Arch Anesth & Crit Care. 2024;.
