Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

Wei Liu, Jingwen Guo, Jun Zheng, Bin Zheng, Xiangcai Ruan, Addition of Dexmedetomidine to Ropivacaine-Induced supraclavicular Block (ADRIB) investigator, Wei Liu, Jingwen Guo, Jun Zheng, Bin Zheng, Xiangcai Ruan, Addition of Dexmedetomidine to Ropivacaine-Induced supraclavicular Block (ADRIB) investigator

Abstract

Purpose: Dexmedetomidine has been proposed as an additive to local anesthetics to prolong peripheral nerve block duration; however, perineural dexmedetomidine has been associated with an increased risk of bradycardia and hypotension This randomized controlled study investigated the effects of low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia.

Methods: Fifty-five patients who had undergone elective upper extremity surgery were randomized to receive an ultrasound-guided supraclavicular brachial plexus block with 20 mL 0.5% ropivacaine with or without 30 μg dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included the onset time and duration of the motor and sensory blocks, incidence of hypotension and bradycardia, total postoperative analgesics, and safety assessment during the 24 h after surgery.

Results: Dexmedetomidine significantly prolonged the duration of analgesia (887 ± 92 min vs 661 ± 83 min, P < 0.0001). The onset time and the duration of motor and sensory block were significantly different between the groups (all P < 0.001). No episodes of hypotension or bradycardia were detected in the dexmedetomidine group. The total postoperative analgesic use and side effect profiles in the first 24 h postoperative period were similar for both groups.

Conclusions: Low-dose dexmedetomidine (30 μg) as a perineural adjuvant significantly prolonged the analgesic duration of a brachial plexus block without inducing hemodynamic instability.

Trial registration: This trial was registered at ClinicalTrial.gov (NCT02630290).

Keywords: Dexmedetomidine; Nerve block; Postoperative pain.

Conflict of interest statement

None declared.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram showing number of patients at each phase of the study
Fig. 2
Fig. 2
Kaplan–Meier survival curves of time to first use of rescue medication in patients receiving control ( ) or dexmedetomidine ( )
Fig. 3
Fig. 3
Postoperative pain scores in patients receiving control ( ) or dexmedetomidine ( ). Boxes indicate median with 25th and 75th percentiles (interquartile range) and whisker caps indicate minimum to maximum values. *P < 0.05, **P < 0.01. VAS, visual analog scale

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