Vanden Eede Hervé, Noels Sophie, Vreven Marco, Dujardyn Jo, Vanden Eede Martin, Branders Jordi, Vanden Eede Lise, De Herdt Gilles, Noels Isabelle, Bouziotis Jason, Saldien Vera
From the Department of Anaesthesiology and Intensive Care, Algemeen Ziekenhuis Rivierenland, Rumst (HVE, MVE, JB), Department of Anaesthesiology, Antwerp University Hospital, University of Antwerp, Edegem (SN, MV, VS), Department of Orthopaedic Surgery, Algemeen Ziekenhuis Rivierenland, Rumst (JD), Faculty of Medicine, University of Leuven, Leuven (LVE, IN), Faculty of Medicine (GDH), Clinical Trial Center, CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium (JB).
Eur J Anaesthesiol. 2025 Sep 1;42(9):808-816. doi: 10.1097/EJA.0000000000002196. Epub 2025 May 13.
The co-administration of intravenous dexamethasone and dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block. The most effective dose with minimal side effects remains undetermined.
To evaluate the difference in time to first analgesic request in patients receiving different doses of intravenous dexmedetomidine after an interscalene brachial plexus block undergoing arthroscopic shoulder surgery.
A double-blind, randomised controlled study.
A single-centre study from November 2021 to December 2023.
Two hundred and eighteen patients undergoing arthroscopic shoulder surgery were included.
Patients were randomly assigned to one of four groups using blocked randomisation: intravenous 0.9% saline (group 1) or intravenous dexmedetomidine: 1.0 (group 2), 1.5 (group 3) and 2.0 (group 4) μg kg -1 .
The primary outcome was the time to first analgesic request in hours.
There was no significant difference in the time to first analgesic request: group 1 (18.8 ± 6.3 h), group 2 (18.7 ± 5.1 h), group 3 (17.7 ± 5.6 h) and group 4 (19.5 ± 5.0 h). There was no significant difference in postoperative nausea and vomiting, patient satisfaction and quality of sleep in the first 24 h. There were significant differences in the incidences of intra-operative hypotension and bradycardia between the control group and all the dexmedetomidine groups combined; however, this study was not powered for this analysis. The time to extubation was statistically significantly higher in group 4 with a prolonged time to extubation (>14 min) when the duration of surgery was shorter (OR 0.98, 95% CI 0.96 to 0.99).
Administering high doses of intravenous dexmedetomidine may not yield additional analgesic benefits after single-shot interscalene brachial plexus block while potentially increasing haemodynamic risks and prolonging time to extubation.
EudraCT 2021-004686-12.
据报道，静脉注射地塞米松与右美托咪定联合使用可延长单次肌间沟臂丛神经阻滞术后的镇痛时间。副作用最小的最有效剂量尚未确定。
评估接受不同剂量静脉注射右美托咪定的患者在肩关节镜手术后进行肌间沟臂丛神经阻滞后首次要求镇痛的时间差异。
一项双盲、随机对照研究。
2021年11月至2023年12月的单中心研究。
纳入218例接受肩关节镜手术的患者。
采用区组随机化将患者随机分为四组之一：静脉注射0.9%生理盐水（第1组）或静脉注射右美托咪定：1.0（第2组）、1.5（第3组）和2.0（第4组）μg kg -1 。
主要观察指标是以小时为单位的首次要求镇痛的时间。
首次要求镇痛的时间无显著差异：第1组（18.8 ± 6.3 h）、第2组（18.7 ± 5.1 h）、第3组（17.7 ± 5.6 h）和第4组（19.5 ± 5.0 h）。术后恶心呕吐、患者满意度和术后24小时内的睡眠质量无显著差异。对照组与所有右美托咪定组联合使用时，术中低血压和心动过缓的发生率存在显著差异；然而，本研究未针对此分析进行效能计算。当手术时间较短时，第4组的拔管时间在统计学上显著延长，拔管时间延长（>14分钟）（OR 0.98，95%CI 0.96至0.99）。
单次肌间沟臂丛神经阻滞后，静脉注射高剂量右美托咪定可能不会产生额外的镇痛益处，同时可能增加血流动力学风险并延长拔管时间。
EudraCT 2021-004686-12。
