Articaine and Dexmedetomidine - Supplemented Articaine for Arteriovenous Fistula Creation under Ultrasound-guided Supraclavicular Block

Simon Halim Armanious, Gamal A Abdelhameed, Simon Halim Armanious, Gamal A Abdelhameed

Abstract

Background: Articaine has emerged as a local anesthetic (LA) that produces sensory and motor blockade shorter than bupivacaine and lower in neurotoxicity than lidocaine. Studies have shown that adding dexmedetomidine to LA produces prolongation of sensory and motor bock duration. Early regain of motor power with adequate analgesia is needed in hemodialysis fistula creation surgery, for early start of physiotherapy. We designed this study to test efficacy of adding dexmedetomidine to articaine on the duration of sensory and motor block.

Methods: After university review board approval, written informed consent to participate in the study was obtained. Patients with chronic renal failure undergoing radiocephalic hemodialysis fistula creation were eligible for enrollment in this double-blind, randomized trial. Patients receive either 40 ml of 2% articaine hydrochloride or 40 ml of articaine 2% mixed with dexmedetomidine (1 μg.kg - 1). Sensory block duration in minutes is assessed by pinprick test and motor block duration in minutes is tested by Bromage scale; both are recorded as a primary outcome. Secondary outcomes, including onset of sensory and motor block, time for rescue analgesia, hemodynamic changes, oversedation, and possible side effect, were recorded.

Results: Fifty patients were enrolled in the study (25 in the articaine Group A and 25 in the articaine and dexmedetomidine group [AD]). Longer sensory block duration was in Group AD (230-260 min) than in Group A (172-185 min) with P < 0.001. In addition, motor block duration was significantly longer in Group AD than in Group A, (220 ± 110 min), (165 ± 45 min), respectively. The duration of effective analgesia was significantly longer in Group AD (363 ± 134 min) versus in Group A (244 ± 84 min). The onset of block was short and similar between groups.

Conclusion: Addition of dexmedetomidine to articaine during arteriovenous fistula creation provide prolongation of sensory and motor block duration and augment analgesia.

Trial registration: This trial was registered at Clinical trial.gov https://ichgcp.net/clinical-trials-registry/NCT04171349 with the identification number NCT04171349.

Keywords: Articaine; dexmedetomidine; hemodialysis fistula creation; supraclavicular block; ultrasound guided.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Anesthesia: Essays and Researches.

References

    1. Malinzak EB, Gan TJ. Regional anaesthesia for vascular access. Anesth Analg. 2009;109:976–80.
    1. Vermeylen K, Engelen S, Sermeus L, Soetens F, van de Velde M. Supraclavicular brachial plexus blocks: Review and current practice. Acta Anaesthesiol Belg. 2012;63:15–21.
    1. Shemesh D, Olsha O, Orkin D, Raveh D, Goldin I, Reichenstein Y, et al. Sympathectomy-like effects of brachial plexus block in arteriovenous access surgery. Ultrasound Med Biol. 2006;32:817–22.
    1. Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmacokinet. 1997;33:417–25.
    1. Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology. 2009;111:406–15.
    1. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010;111:1548–51.
    1. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109:502–11.
    1. Yapp KE, Hopcraft MS, Parashos P. Articaine: A review of the literature. Br Dent J. 2011;210:323–9.
    1. Ogle OE, Mahjoubi G. Local anesthesia: Agents, techniques, and complications. Dent Clin North Am. 2012;56:133–48, i×.
    1. Choi S, Rodseth R, McCartney CJ. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: A systematic review and meta-analysis of randomized trials. Br J Anaesth. 2014;112:427–39.
    1. Simon MA, Vree TB, Gielen MJ, Booij LH, Lagerwerf AJ. Similar motor block effects with different disposition kinetics between lidocaine and (+ or -) articaine in patients undergoing axillary brachial plexus block during day case surgery. Int J Clin Pharmacol Ther. 1999;37:598–607.
    1. Bartlett G, Mansoor J. Articaine buccal infiltration vs lidocaine inferior dental block-A review of the literature. Br Dent J. 2016;220:117–20.
    1. Hutton M, Brull R, McFarlane A. Regional anesthesia and outcomes. BJA Educ. 2018;18:52–6.
    1. Vetter TR, Boudreaux AM, Jones KA, Hunter JM, Jr, Pittet JF. The perioperative surgical home: How anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118:1131–6.
    1. Swami SS, Keniya VM, Ladi SD Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as adjuvant to local anesthesia in supraclavicular brachial plexus block: A randomized double -blind prospective study. Indian J Anesthesia. 2012;56:243–9.
    1. 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.
    1. Das B, Lakshmegowda M, Sharma M, Mitra S, Chauhan R. Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study. Rev Esp Anestesiol Reanim. 2016;63:135–40.
    1. Gandhi R, Shah A, Patel I. Use of dexmedetomidine alone with bupivacaine for brachial plexus block. Nat J Med Res. 2012;2:67–9.

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