Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial
Dexmedetomidina versus sufentanil como adjuvantes da bupivacaína para bloqueio do plexo braquial durante cirurgia de membros superiores: um ensaio clínico randomizado
Ali Ghasemi, Mohsen Chamanara, Babak Paknejad, Mojtaba Yousefizoshk, Ebrahim Hazrati
Abstract
Background
Brachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB.
Methods
In this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to 2 equal study groups (n = 20), receiving 1 mL of 5 µg.mL-1 sufentanil (group S) or 1 mL of 100 µg.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40).
Results
The duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0∼130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0∼130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0∼7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0∼-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting.
Conclusion
Our study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.
Keywords
Resumo
Introdução
O bloqueio do plexo braquial (BPB) tem sido aceito como alternativa confiável para anestesia geral em cirurgias de membros superiores. A adição de medicamentos adjuvantes como dexmedetomidina e sufentanil demonstrou ter vantagens clínicas e farmacológicas. Neste ensaio clínico paralelo randomizado, pretendemos comparar os efeitos desses dois adjuvantes da bupivacaína na BPB.
Métodos
Neste estudo duplo-cego, utilizando randomização em bloco assistida por computador, 40 pacientes com idades entre 20 e 65 anos e agendados para cirurgias eletivas de membros superiores foram divididos em dois grupos de estudo iguais (n = 20), recebendo 1 mL de 5 μg .mL-1 de sufentanil (grupo S) ou 1 mL de dexmedetomidina 100 μg.mL-1 (grupo D) em conjunto com 30 mL de bupivacaína a 0,5% para BPB supraclavicular sob orientação de ultrassonografia. Foram avaliadas características da anestesia local e da analgesia pós-operatória (n = 40).
Resultados
A duração dos bloqueios melhorou significativamente no grupo S (sensorial: diferença mediana estimada (DME) [IC95%] = 100,0 [70,0∼130,0], p < 0,001; motor: DME [IC95%] = 120,0 [100,0∼130,0] , p < 0,001). O Grupo S também apresentou analgesia pós-operatória significativamente mais longa e menor consumo de opioides nas 24 horas após a cirurgia (DME [IC95%] = 4,0 [3,0∼7,0], p < 0,001; DME [IC95%] = -5,0 [-5,0∼ -5,0], p < 0,001; respectivamente). Nenhum dos pacientes apresentou efeitos adversos em relação aos sinais vitais, náuseas ou vômitos.
Conclusão
Nosso estudo mostrou que durante o BPB supraclavicular guiada por ultrassom, o sufentanil é uma escolha bastante melhor do que a dexmedetomidina como adjuvante da bupivacaína e pode fornecer bloqueios sensoriais e motores preferíveis. Nenhum efeito colateral significativo foi observado em nenhum dos grupos de estudo.
Palavras-chave
References
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Submitted date:
09/18/2020
Accepted date:
03/19/2021
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