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Chen JB, Su LM, Zhang XQ, Liu Y, Li XS, Chen ZY. Ropivacaine combined with dexmedetomidine in ultrasound-guided axillary brachial plexus block in children, a randomized controlled trial. Eur J Med Res 2024; 29:416. [PMID: 39138539 PMCID: PMC11321016 DOI: 10.1186/s40001-024-01997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE In this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia. METHODS We enrolled 90 children (aged 1-8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications. RESULTS There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05). CONCLUSION Dexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery. CLINICAL REGISTRY NUMBER Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.
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Affiliation(s)
- Jian-Bin Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China
- Department of Anesthesiology, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, No.92-98 of Yibin Road, Huli District, Xiamen, 361000, China
| | - Li-Ming Su
- Department of Intensive Care Unit, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, No.92-98 of Yibin Road, Huli District, Xiamen, 361000, China
| | - Xiao-Qi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Ying Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Xue-Shan Li
- Department of Anesthesiology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, 365000, China.
| | - Zhi-Yuan Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China.
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Berthier F, Samain E, Vettoretti L, Maillot C, Besch G, Ferreira D. Impact of intravenous dexamethasone and perineural ropivacaine on axillary block duration: analysis of two single-centre randomised trials. Br J Anaesth 2024; 133:211-213. [PMID: 38679517 DOI: 10.1016/j.bja.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Francis Berthier
- Université de Franche-Comté, CHU Besançon, INSERM CIC 1431, SINERGIES, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France.
| | - Emmanuel Samain
- Université de Franche-Comté, CHU Besançon, SINERGIES, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France
| | - Lucie Vettoretti
- CHU Besançon, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France
| | - Clémence Maillot
- CHU Besançon, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France
| | - Guillaume Besch
- Université de Franche-Comté, CHU Besançon, INSERM CIC 1431, SINERGIES, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France
| | - David Ferreira
- Université de Franche-Comté, CHU Besançon, LINC, Département d'Anesthésie Réanimation Chirurgicale, Besançon, France
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Wu L, Zhang W, Zhang X, Wu Y, Qu H, Zhang D, Wei Y. Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1288697. [PMID: 38035018 PMCID: PMC10687368 DOI: 10.3389/fphar.2023.1288697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Aim of the Study: Brachial plexus block (BPB) is widely used for patients undergoing upper limb surgeries. Ropivacaine is the most commonly used local anesthetic for BPB. This study aimed to identify the optimal ropivacaine concentration for BPB in adult patients undergoing upper limb surgeries. Materials and Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the effects of different concentrations of ropivacaine for BPB in adult patients undergoing upper limb surgeries. The primary outcomes were the onset time of sensory and motor block. RevMan 5.4 software was used for analysis. The GRADE approach was used to assess evidence quality. Results: Nine studies involving 504 patients were included. Compared to 0.5% ropivacaine, 0.75% ropivacaine shortened the onset time of sensory (WMD, -2.54; 95% CI; -4.84 to -0.24; <0.0001, moderate quality of evidence) and motor blockade (WMD, -2.46; 95% CI, -4.26 to -0.66; p = 0.01; moderate quality of evidence). However, 0.5% and 0.75% ropivacaine provided similar duration time of sensory (WMD, -0.07; 95% CI, -0.88 to 0.74; p = 0.81; high quality of evidence) and motor blockade (WMD, -0.24; 95% CI, -1.12 to 0.65; p = 0.55; high quality of evidence), as well as time to first request for oral analgesia (WMD, -1.57; 95% CI, -3.14 to 0.01; p = 0.5; moderate quality of evidence). Conclusion: Moderate-quality evidence suggested that, in terms of the onset time of sensory and motor blockade, 0.75% ropivacaine is a preferred concentration for BPB in upper limb surgeries. Systematic Review Registration: identifier CRD42023392145.
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Affiliation(s)
- Lin Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Zhang
- Department of Anesthesiology, First People’s Hospital of Tianshui City, Tianshui, China
| | - Yinglong Wu
- Department of Anesthesiology, Pu’er People’s Hospital, Pu'er, China
| | - Hua Qu
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Donghang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yiyong Wei
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
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Cao R, Li X, Yang J, Deng L, Cui Y. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided quadratus lumborum block for analgesia after cesarean delivery: a dose finding study. BMC Anesthesiol 2022; 22:410. [PMID: 36581811 PMCID: PMC9798625 DOI: 10.1186/s12871-022-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Quadratus lumborum block was recently proposed as an alternative technique for post-cesarean delivery analgesia. However, there is not a definite optimum concentration of local anesthetics. A biased coin design up-and-down method was used to explore the minimum effective concentration of ropivacaine in quadratus lumborum block for satisfactory analgesia after cesarean delivery. METHODS Fifty-six patients weighing 60-80 kg after cesarean section and with ages between 18 and 40 years were recruited. For the posterior quadratus lumborum block, a volume of 25 ml of the assigned concentration of ropivacaine was injected bilaterally. The concentration administered to each patient depended on the response to the previous dose. The first patient received 0.25%. If a successful block was observed, the next patient was randomized to receive the same ropivacaine concentration (with a probability of 0.89) or 0.025% less (with a probability of 0.11). After any block failure, the concentration was always increased by 0.025% for the next. The study ended when 45 successful blocks were obtained. We defined effective quadratus lumborum block as a resting visual analog score ≤ 3 and the absence of a need for rescue anesthetics. RESULTS The 90% minimum effective concentration of ropivacaine was 0.335% (95% CI 0.306 to 0.375%), and the 99% minimum effective concentration was 0.371% (95% CI 0.355 to 0.375%). The sufentanil consumption was 11 (11,13) and 24 (22,27) μg at 12 and 24 hours after quadratus lumborum block, respectively. CONCLUSIONS The optimum dosage of ropivacaine is a 25 ml volume of 0.335% for quadratus lumborum block after cesarean delivery. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000040415 ).
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Affiliation(s)
- Rong Cao
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Xuehan Li
- grid.412901.f0000 0004 1770 1022Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Lingmei Deng
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Yu Cui
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
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Xu C, Gu F, Liu Y, Chen R, Wang C, Lu J. The median effective analgesic concentration of ropivacaine in ultrasound-guided interscalene brachial plexus block after arthroscopic rotator cuff repair. Front Pharmacol 2022; 13:928227. [PMID: 36059976 PMCID: PMC9428620 DOI: 10.3389/fphar.2022.928227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The median effective analgesic concentration (MEAC) of ropivacaine in interscalene brachial plexus block (ISBPB) for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) has not been determined. Therefore, this study aimed to evaluate the MEAC after ARCR using 10 ml ropivacaine. Method: This study was conducted on 40 patients with American Society of Anesthesiologists grade I or II who had selective ARCR. The 10 ml ropivacaine was administered for determined, with an initial concentration of 0.3% using up-and-down sequential allocation. After successful or unsuccessful postoperative analgesia, the concentration of ropivacaine was decreased or increased by 0.05% in the next patient. We defined successful postoperative analgesia as a visual analog scale score of <4 at rest within the initial 8 h after ISBPB. The analytic techniques of linear, linear-logarithmic, exponential regressions and centered isotonic regression were used for calculating MEAC. The secondary outcomes was sufentanil consumption, time to 1st rescue analgesic, onset time of sensory block and motor block. Results: The concentration of ropivacaine administered ranged from 0.1% to 0.35%. The MEAC from the four different methods (linear, linear-logarithmic, exponential regressions and centered isotonic regression) were 0.207% (95% CI, 0.168–0.355%), 0.182% (95% CI, 0.165–0.353%), 0.196% (95% CI, 0.154–0.356%), and 0.163%, respectively. Of the four models, exponential regression had the least residual standard error (0.0990). Conclusion: The MEAC derived from the four statistical models for 10 ml ropivacaine in ultrasound-guided ISBPB for postoperative analgesia was distributed within a narrow range of 0.163%–0.207%. The exponential regression model calculated by the goodness-of-fit test at a concentration of 0.196% best fits the study data. Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=127449, identifier ChiCTR2100047978
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Affiliation(s)
| | | | | | | | | | - Jie Lu
- *Correspondence: Chengyu Wang, ; Jie Lu,
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