Perineural dexamethasone reduces rebound pain after ropivacaine single injection interscalene block for arthroscopic shoulder surgery: a randomized controlled trial

2021 ◽  
pp. rapm-2021-102795
Author(s):  
Jae Hee Woo ◽  
Hyun Jung Lee ◽  
Hye-Won Oh ◽  
Jong Wha Lee ◽  
Hee Jung Baik ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Single Injection ◽  
Controlled Trial ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Dexamethasone Group ◽  
Arthroscopic Shoulder Surgery

Background and objectivesA single injection interscalene block (ISB) is a common regional analgesic technique in patients undergoing arthroscopic shoulder surgery. However, rebound pain after ISB resolution may reduce its overall benefit. Our primary aim was to assess whether perineural dexamethasone reduces the intensity and incidence of rebound pain in patients undergoing arthroscopic shoulder surgery under general anesthesia combined with a preoperative single injection ISB.MethodsThe patients were randomly assigned to receive single injection ISB using either 0.5% ropivacaine (control) or 0.5% ropivacaine containing 5 mg of dexamethasone. The primary outcomes were the pain score difference before and after ISB resolution, and the incidence of rebound pain. The secondary outcomes were the onset and duration of rebound pain, the presence of sleep disturbances due to postoperative pain, the first time when an analgesic was requested, and pain scores at various predefined time points.ResultsPain increase following ISB resolution was lower in the dexamethasone group compared with the control group (4.5±2.4 and 6.9±2.2, respectively, p<0.001). The incidence of rebound pain was significantly lower in the dexamethasone group compared with the control group (37.1% and 82.9%, respectively, p<0.001). The controls experienced greater sleep disturbance during the postoperative period compared with those who received ISB with perineural dexamethasone.ConclusionsPerineural dexamethasone added to ISB using ropivacaine led to a much smoother resolution of ISB, reflected in a significantly smaller increase in pain after block resolution, a lower incidence of rebound pain and a lower sleep disturbance during the first postoperative week.Trial registration numberClinical Trial Registry of Korea (KCT0004418).

scholarly journals Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Roman Margulis ◽  
Jacquelyn Francis ◽  
Bryan Tischenkel ◽  
Adam Bromberg ◽  
Domenic Pedulla ◽  
...  
Keyword(s):  
Shoulder Surgery ◽  
Opioid Consumption ◽  
Sensory Function ◽  
Interscalene Block ◽  
Ultra Sound ◽  
Controlled Study ◽  
Control Group ◽  
Dexamethasone Group ◽  
Arthroscopic Shoulder Surgery ◽  
First Pain

Background: Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries. Objectives: The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting. Methods: In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured. Results: The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573). Conclusions: There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated.

scholarly journals A Comparison of Anesthetic Quality Between Interscalene Block and Superior Trunk Block for Arthroscopic Shoulder Surgery: A Randomized Controlled Trial

2021 ◽  
pp. 235-242
Author(s):  
Hyeon Ju Shin
Keyword(s):  
Randomized Controlled Trial ◽  
Brachial Plexus ◽  
Local Anesthesia ◽  
Brachial Plexus Block ◽  
Controlled Trial ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Randomized Controlled ◽  
Arthroscopic Shoulder Surgery ◽  
Plexus Block

Background: Interscalene block is the most commonly used nerve block for shoulder surgery, and superior trunk block has been investigated as a phrenic-sparing alternative. This randomized controlled trial compared ultrasound-guided interscalene block and superior trunk block as anesthesia for arthroscopic shoulder surgery. Objectives: Our aims were to determine the superiority of anesthesia quality and compare the risk of hemidiaphragmatic paralysis between these 2 blocks. Study Design: A randomized, controlled trial. Setting: Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital. Methods: Forty-eight patients undergoing elective arthroscopic shoulder surgery under an ultrasound guided brachial plexus block were randomized to receive either an interscalene block (ISB group, n = 24) or a superior trunk block (STB group, n = 24) for surgery. Ten milliliters of 2% lidocaine and 10 mL of 0.75% ropivacaine were used as local anesthesia in both brachial plexus block groups (total 20 mL). In the ISB group, the local anesthesia was injected between the C5–C6 root and at the upper part of C5 with equally divided doses. In the STB group, the local anesthesia was injected into the anterior and posterior parts of the superior trunk with equally divided doses. Sensory blockade of each trocar’s insulting site (supraclavicular, axillary, and suprascapular nerve areas) and motor blockade of the axillary nerve (shoulder abduction) and the suprascapular nerve (shoulder external rotation) were assessed by a blinded observer at 5-minute intervals for 30 minutes after the block. Anesthesia quality was assessed using 3 grades (excellent/insufficient/failure). The blinded investigator also assessed the grade of hemidiaphragmatic paralysis (normal/partial/complete) by comparing pre- and postoperative chest radiographs. Primary outcome variables were anesthesia grade and rate of hemidiaphragmatic paralysis. Secondary outcome variables were performance time and anesthesia onset time. Results: The anesthetic grade was significantly different between the 2 groups (22/2/0 in the ISB group vs. 16/3/5 in the STB group, P = 0.046). Both groups displayed equivalent incidence of hemidiaphragmatic paralysis (12/6/6 in the ISB group vs. 7/14/3 in the STB group, P = 0.063). No intergroup differences were found in terms of performance time and anesthesia onset time. Limitations: Our sensory and motor function test was not applied to the subscapular nerve, which serves internal rotation of the humeral head so may be difficult to evaluate in patients with rotator cuff tears. We assessed the diaphragmatic movement by chest radiographs instead of by ultrasound. Conclusions: The superior trunk block provided lower quality of surgical anesthesia than the interscalene block and did not effectively decrease the risk of hemidiaphragmatic paralysis during arthroscopic shoulder surgery for rotator cuff syndrome. Key words: Brachial plexus block, hemidiaphragmatic paralysis, interscalene block, superior trunk block, ultrasound

scholarly journals The effect of perineural dexamethasone on rebound pain after ropivacaine single-injection nerve block: A randomized controlled trial

2020 ◽  
Author(s):  
Jie Fang ◽  
Yuncen Shi ◽  
Fang Du ◽  
Zhanggang Xue ◽  
Jing Cang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Nerve Block ◽  
Pain Therapy ◽  
Controlled Trial ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Single Shot ◽  
Clinical Trial Registry ◽  
Patient’S Satisfaction ◽  
Dexamethasone Group

Abstract Background：Rebound pain after single shot nerve block challenges the real benefit of this technique. We aimed to investigate whether perineural dexamethasone addition decreased the incidence of rebound pain after a single shot nerve block.Methods：We randomly allocated 132 patients scheduled for open reduction, and internal fixation of upper extremity closed fracture under single-shot peripheral nerve block and sedation into two groups. Patients in the dexamethasone group receiving nerve block with 0.375% ropivacaine and 8 mg dexamethasone while those in the control group received ropivacaine only. Sixty-three cases in the dexamethasone group and 60 cases in the control group were analyzed for the incidence of rebound pain in 48 h after the block administration. The primary outcome was the incidence of rebound pain in 48 h after the block administration. Secondary outcomes included the self-reported highest NRS score, pain intensity at 8h, 12h, 24h, 48h after the block, sufentanil consumption, sleep quality on the night of surgery, patient’s satisfaction to the pain therapy, blood glucose at 6h after the block, pain and paresthesia at 30 days after surgery.Results: The incidence of rebound pain was significantly lower in the dexamethasone group (7[11.1%] of 63 patients) than that in the control group (28[48.8%] of 60 patients; Relative risk (RR) is 0.238, 95% CI 0.113-0.504,p=0.001). Dexamethasone decreased the opioid consumption in 24 h after the surgery (p<0.001), improved the sleep quality score on the night of surgery(p=0.01) and satisfaction to the pain therapy(p=0.001). Multivariate logistic regression analysis showed that only group allocation was significantly associated with the occurrence of rebound pain[OR=0.131,95%CI (0.047-0.364)].Patients in the dexamethasone group reported later onset (19.7±6.6 h vs 14.7±4.8 h since block administration, mean±SD, p<0.001) lower peak NRS score [5 (3,6) vs 8 (5,9) , median(IQR), p<0.001] compared with those in the control group.Conclusions: Perineural administration of 8mg dexamethasone reduces rebound pain after a single-shot nerve block in patients receiving ORIF of upper limb fracture.Trial registration: This study was registered in Chinese Clinical Trial Registry (ChiCTR-IPR-17011365). The study was registered on May 11th , 2017. Retrospectively registered.

scholarly journals Efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke: A multicenter, randomized, double-blind, placebo-controlled trial

2020 ◽  
Author(s):  
Jun Ni ◽  
Huisheng Chen ◽  
Guofang Chen ◽  
Yong Ji ◽  
Fei Yi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Controlled Trial ◽  
Survival Rates ◽  
Control Group ◽  
Efficacy And Safety ◽  
Clinical Trial Registry ◽  
Double Blind

Abstract Background: Ischemic stroke is a leading cause of morbidity and mortality. Thrombolytic therapy improves disability and survival rates; however, to be effective, it must be given within 4.5 hours of onset. Moreover, thrombolytic therapy is frequently contraindicated. Therefore, alternative therapeutic options are required. In China, cinepazide maleate injection has been shown to improve the cerebral collateral circulation and further reduce disability in stroke patients; however, very few studies investigating this therapy have been conducted to date. Therefore, this study aimed to further confirm the efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke.Methods: Patients with acute ischemic stroke were administered an intravenous infusion of 320 mg cinepazide maleate or placebo once daily for 14 days. All patients were also administered basic therapy (citicoline sodium). The primary efficacy endpoint was the proportion of patients with a modified Rankin scale (mRS) ≤2 on day 90. Secondary efficacy endpoints included Barthel Index ≥95. Safety was evaluated by recording all adverse events (AEs), monitoring laboratory parameters and vital signs, and electrocardiogram.Results: In total, 937 patients with an acute ischemic stroke were included, with a mean (standard deviation, SD) National Institutes of Health Stroke Scale score of 8.8 (2.4) and a mean (SD) stroke onset of 30.9 (11.4) hours prior. Following treatment for 90 days, the proportion of patients with an mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group (60.9% vs. 50.1%; p=0.0004). Moreover, the proportion of patients with a Barthel Index of ≥95 on day 90 was also significantly higher in the cinepazide maleate group than in the control group (53.4% vs. 46.7%; p=0.0230). There were no statistically significant differences in safety parameters between the cinepazide maleate and control groups.Conclusions: The results of this study show that cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery in patients with acute ischemic stroke. Cinepazide maleate injection was safe and well tolerated with no unexpected AEs reported.Trial registration: Chinese Clinical Trial Registry CTR20160292 and ChiCTR1900023827. Retrospectively registered June 13, 2019.

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