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A rise in the number of automated vehicles increases the incidence of various types of traffic traumas.
The
combinatorial therapy consisting of ropivacaine with dexmedetomidine generates
a superior brachial plexus blocking effect than ropivacaine monotherapy, both
intraoperatively and postoperatively.
A rise in the number of automated vehicles
increases the incidence of various types of traffic traumas. Upper limb
fracture is one of them. Management of severe pain in upper limb fractures is
achieved with analgesia by brachial plexus blockade. It is usually applied
before surgery. However, patients remain anxious and nervous before and during
operation, leading to heart rate (HR) decrease, blood pressure increase and
even shock.
Administration of appropriate analgesics is
integral. Traditional analgesics such as fentanyl were more prone to over
anaesthesia, increased perioperative risks and are not conducive to
postoperative recovery. Brachial plexus regional anaesthesia is the preferred
treatment option for upper limb fracture surgery because it is easy to execute
and can be done in the waking state during operation. At present, the technique
of brachial plexus blockade is performed under the guidance of ultrasonography,
where local anaesthetics are continuously injected into the location to be
blocked via a connection tube installed by visualisation technique. The
technique is easy to use and helps in dose adjustment of anaesthetic according
to operative time and analgesic requirement of patients.
To achieve a stronger anaesthetic effect,
the route and choice of anaesthetics are essential. An ideal sedative is the
one that can produce a robust anaesthetic effect without the incidence of
adverse effects. Ropivacaine is one such local anaesthetic that inhibits
neuronal excitement and conduction by blocking neuronal sodium channels. It
generates a stronger anaesthetic effect by producing nerve inhibitory effect at
low concentrations. The effects are long lasting with a weak central nerve
inhibitory activity, making it a commonly used anaesthetic in nerve block
anaesthesia. It also generates a vasoconstrictive effect resulting in reduced
drug absorption in plasma and a long-lasting effect. It is also used in ideal
anaesthetics in relieving a variety of postoperative pain. Dexmedetomidine, a
highly selective α2 adrenergic receptor agonist, shows a higher affinity for
its receptor and 7-8 times more effective than clonidine, that belongs to the
same class. It also shows a faster onset of action and long lasting effect. It
can also be used as an analgesic, sedative and anxiolytic agent. Previous
studies have revealed the neuroprotective effects of dexmedetomidine by an
increase in calcium levels and the reduction in the concentration of
catecholamines. Thus, it can also be used as an adjuvant in anaesthesia.
Rationale behind research:
Several
studies have determined the dose and efficacy of the combination of two
anaesthetics in different race cohorts, but a few studies have elucidated the
efficacy of the ropivacaine-dexmedetomidine combination. Therefore, the present
study investigated the analgesic effect of ropivacaine-dexmedetomidine in
brachial plexus block and compared its effect with that of ropivacaine alone.
Objective:
The study was intended to evaluate the
efficacy and safety of ropivacaine in combination with dexmedetomidine versus
ropivacaine alone in 114 patients with upper limb surgery.
Study outcomes:
Time Points: 0, 4, 8, 12 and 24 h
Outcomes:
Baseline: There were
no significant differences observed at baseline
Study outcomes:
The study indicated that the combination of ropivacaine with dexmedetomidine was effective in reducing VAS scores 8 to 24 h postoperatively when compared with ropivacaine alone in the management of upper limb surgery. Combination regimen was more effective in alleviating postoperative pain than ropivacaine alone. The improvement in pain reduction was observed due to longer blocking effects by the combination therapy on sensory and motor nerves. The study also established that ropivacaine also with dexmedetomidine offers higher efficacy and safety than ropivacaine alone.
Combination of two kinds of anaesthetics can yield a synergistic effect leading to a reduction in the dose of both the drugs. Combination regimen induces a faster blockade onset, longer nerve blocking effect and lower VAS scores with significant improvement in vital signs such as HR, blood pressure and SPO2, and can reduce the incidence of adverse reactions. The results were consistent and superior in various aspects such as larger sample size, broader parameters (VAS score for assessing the anaesthetic effect) and a detailed description of adverse effects. The significant adverse effects reported were lethargy and nausea. The cases of adverse effects were few and more studies are required to verify the incidence of adverse effects.
The combination use of dexmedetomidine and
ropivacaine in the brachial plexus block has a good analgesic effect with
reduced adverse effects as compared with ropivacaine alone. The purpose of
dexmedetomidine and ropivacaine is worth promoting widely.
BMC Anesthesiology2018.18:107.
Analgesic effect of Ropivacaine combined with Dexmedetomidine on brachial plexus block
Zhenqing Liu et al.
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