High-dose dexmedetomidine versus dexamethasone supplementation to interscalene brachial plexus block in arthroscopic shoulder surgery: A randomized, controlled trial.
Dexmedetomidine nerve block adjuvant increased intraoperative hypotension without prolonging analgesia duration
High-dose dexmedetomidine versus dexamethasone supplementation to interscalene brachial plexus block in arthroscopic shoulder surgery: A randomized, controlled trial.
In this double-blind, randomized controlled trial, we compared the efficacy of perineural 2 µg/kg dexmedetomidine and 5 mg dexamethasone as adjuvants to bupivacaine for postoperative pain control in patients undergoing arthroscopic shoulder surgery.
We hypothesized that the combination of bupivacaine with dexmedetomidine would prolong analgesia compared with dexamethasone.
One hundred twelve patients scheduled for arthroscopic shoulder surgery were randomized to receive 15 mL of 0.33% bupivacaine with either 2 µg/kg of dexmedetomidine or 5 mg of dexamethasone during ultrasound-guided interscalene brachial plexus block (ISB).
dexmedetomidine caused hypotension far more often than dexamethasone
Dexmedetomidine and dexamethasone produced a similar duration of analgesia (median, 16.77 vs 12.48 h; median difference in location 5.24 h, 95% CI -0.47 to 9.17; p = 0.655).
Postoperative pain score at 6, 12, 18, and 24 hours were comparable, as were rebound pain, postoperative nausea and vomiting (postoperative nausea and vomiting), patient satisfaction, and opioid consumption.
Perineural dexmedetomidine (2 µg/kg) was not shown to be superior to dexamethasone (5 mg) in prolonging analgesia when added to bupivacaine for ISB in arthroscopic shoulder surgery.
Although dexmedetomidine prolonged sensory and motor block duration, this did not translate into a longer duration of analgesia and was associated with higher rates of hemodynamic instability and sedation.
These findings suggest limited clinical benefit and raise safety concerns regarding higher dexmedetomidine doses.