{"title":"Efficacy and Safety of Adding 1μg/Kg Dexmedetomidine to 20ml Bupivacaine in Supraclavicular Brachial Plexus Block: A Randomized Trial.","authors":"Basma M Ghoniem, Gamal Hendawy Shams, Wafaa Abdelsalam, Mahmoud Fawzy Elsharkawy","doi":"10.2174/0115748863332349241108094956","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>For surgical procedures of the upper limbs, ultrasound-guided supraclavicular brachial plexus block (SCBPB) represents a safe substitute for general anesthesia. The present study evaluated the effectiveness and safety of incorporating 1μg/kg dexmedetomidine (DEX) into 20 ml bupivacaine, as opposed to using 20 ml and 30 ml bupivacaine without additives, in SCBPB.</p><p><strong>Methods: </strong>This randomized, controlled, double-blind study included 75 patients assigned to elective upper-limb surgery under the mid-humerus level. Patients were randomized into three equal groups to receive US-guided SCBPB with 20 ml bupivacaine 0.5% + 1 μg/kg DEX in group BD, 20 ml bupivacaine 0.5% without additives in group B20, and 30 ml bupivacaine 0.5% in group B30 (control).</p><p><strong>Results: </strong>Compared to group B20, groups BD and B30 had significantly quicker onset times for sensory and motor blocks. Groups BD and B30 had a more significant block duration than group B20. Group BD experienced considerably lower intraoperative hemodynamics than groups B20 and B30. Groups BD and B30 had a significantly delayed time to first rescue analgesia and consumed less pethidine than group B20. Compared to group B20, the pain score was significantly reduced in groups BD and B30. Comparable levels of pain score, rescue analgesia time, total pethidine consumption, and motor and sensory block onset and duration were seen in the BD and B30 groups.</p><p><strong>Conclusion: </strong>DEX with a lower volume(20 ml) of bupivacaine reaches the same result as a higher volume of bupivacaine(30ml) in managing perioperative pain and hemodynamic stability without the risk of the high volume of bupivacaine. Further, adding DEX to small dose of bupivacaine (20ml) is more effective than small dose of bupivacaine(20ml) alone without additives in prolonging the duration of sensory and motor block, reducing pain intensity, and delaying the need for rescue analgesia.</p>","PeriodicalId":10777,"journal":{"name":"Current drug safety","volume":" ","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current drug safety","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2174/0115748863332349241108094956","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: For surgical procedures of the upper limbs, ultrasound-guided supraclavicular brachial plexus block (SCBPB) represents a safe substitute for general anesthesia. The present study evaluated the effectiveness and safety of incorporating 1μg/kg dexmedetomidine (DEX) into 20 ml bupivacaine, as opposed to using 20 ml and 30 ml bupivacaine without additives, in SCBPB.
Methods: This randomized, controlled, double-blind study included 75 patients assigned to elective upper-limb surgery under the mid-humerus level. Patients were randomized into three equal groups to receive US-guided SCBPB with 20 ml bupivacaine 0.5% + 1 μg/kg DEX in group BD, 20 ml bupivacaine 0.5% without additives in group B20, and 30 ml bupivacaine 0.5% in group B30 (control).
Results: Compared to group B20, groups BD and B30 had significantly quicker onset times for sensory and motor blocks. Groups BD and B30 had a more significant block duration than group B20. Group BD experienced considerably lower intraoperative hemodynamics than groups B20 and B30. Groups BD and B30 had a significantly delayed time to first rescue analgesia and consumed less pethidine than group B20. Compared to group B20, the pain score was significantly reduced in groups BD and B30. Comparable levels of pain score, rescue analgesia time, total pethidine consumption, and motor and sensory block onset and duration were seen in the BD and B30 groups.
Conclusion: DEX with a lower volume(20 ml) of bupivacaine reaches the same result as a higher volume of bupivacaine(30ml) in managing perioperative pain and hemodynamic stability without the risk of the high volume of bupivacaine. Further, adding DEX to small dose of bupivacaine (20ml) is more effective than small dose of bupivacaine(20ml) alone without additives in prolonging the duration of sensory and motor block, reducing pain intensity, and delaying the need for rescue analgesia.
背景：对于上肢外科手术，超声引导的锁骨上臂丛阻滞（SCBPB）是全身麻醉的安全替代品。本研究评估了在20ml布比卡因中加入1μg/kg右美托咪定（DEX）的有效性和安全性，而不是在SCBPB中使用20ml和30ml不含添加剂的布比卡因。方法：这项随机、对照、双盲研究包括75名患者，他们被分配到肱骨中段以下择期上肢手术。患者随机分为三组，分别接受美国导引下的SCBPB治疗，BD组20 ml 0.5%布比卡因+ 1 μg/kg DEX， B20组20 ml不含添加剂的0.5%布比卡因，B30组30 ml 0.5%布比卡因（对照组）。结果：与B20组相比，BD组和B30组感觉和运动阻滞的发病时间明显缩短。BD组和B30组的阻滞持续时间显著高于B20组。BD组术中血流动力学明显低于B20和B30组。与B20组相比，BD组和B30组首次抢救镇痛时间明显延迟，哌啶用量明显减少。与B20组比较，BD组和B30组疼痛评分明显降低。在BD组和B30组中，疼痛评分、抢救镇痛时间、总哌啶消耗量、运动和感觉阻滞的发生和持续时间水平相当。结论：低剂量布比卡因（20ml）与大剂量布比卡因（30ml）在控制围手术期疼痛和血流动力学稳定性方面效果相同，且无大剂量布比卡因的风险。此外，在小剂量布比卡因（20ml）的基础上加DEX比单独使用小剂量布比卡因（20ml）在延长感觉和运动阻滞持续时间、减轻疼痛强度、延迟救援镇痛的需要方面更有效。
期刊介绍：
Current Drug Safety publishes frontier articles on all the latest advances on drug safety. The journal aims to publish the highest quality research articles, reviews and case reports in the field. Topics covered include: adverse effects of individual drugs and drug classes, management of adverse effects, pharmacovigilance and pharmacoepidemiology of new and existing drugs, post-marketing surveillance. The journal is essential reading for all researchers and clinicians involved in drug safety.
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