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Bodenbender JP, Eberhart L, Paul C, Wiesmann T, Schubert F, Schubert AK, Dinges HC. Efficacy of adjuvants in ophthalmic regional anesthesia: A systematic review and network meta-analysis. Am J Ophthalmol 2023; 252:26-44. [PMID: 36906095 DOI: 10.1016/j.ajo.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE This network meta-analysis aims to determine the differences between adjuvants that are used in combination with local anesthetics for ophthalmic regional anesthesia. DESIGN Systematic review and network meta-analysis METHODS: A systematic literature search for randomized controlled trials, comparing the impact of adjuvants in ophthalmic regional anesthesia, in Embase, CENTRAL, MEDLINE and Web of Science was performed. Risk of bias was evaluated using the Cochrane risk of bias tool. Frequentist network meta-analysis was performed using a random effects model with saline as the comparator. Primary endpoints were the onset and the duration of sensory block and globe akinesia, as well as the duration of analgesia. Summary measure was the ratio of means (ROM). Secondary endpoints were the rates of side effects and adverse events. RESULTS 39 trials were identified as eligible for network meta-analysis, including 3046 patients. 17 adjuvants were compared in the most extensive network (onset of globe akinesia). The addition of fentanyl (F), clonidine (C) or dexmedetomidine (D) showed the best overall results. Onset of sensory block: F 0.58 [CI 0.47-0.72], C 0.75 [0.63-0.88], D 0.71 [0.61-0.84], onset of globe akinesia: F 0.71 [0.61-0.82], C 0.70 [0.61-0.82], D 0.81 [0.71-0.92], duration of sensory block: F 1.20 [1.14-1.26], C 1.22 [1.18-1.27], D 1.44 [1.34-1.55], duration of globe akinesia: F 1.38 [1.22-1.57], C 1.45 [1.26-1.67], D 1.41 [1.24-1.59], duration analgesia: F 1.46 [1.33-1.60], C 1.78 [1.63-1.96], D 1.41 [1.28-1.56]. CONCLUSION The addition of fentanyl, clonidine or dexmedetomidine showed beneficial effects regarding onset and duration of sensory block and globe akinesia.
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Affiliation(s)
| | - Leopold Eberhart
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - Christoph Paul
- Department of Ophthalmology, University Hospital Marburg, Marburg, Germany
| | - Thomas Wiesmann
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - Florian Schubert
- Department of Ophthalmology, University Hospital Marburg, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - Hanns-Christian Dinges
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
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Costa GL, Leonardi F, Interlandi C, Spadola F, Fisichella S, Macrì F, Nastasi B, Macrì D, Ferrantelli V, Di Pietro S. Levobupivacaine Combined with Cisatracurium in Peribulbar Anaesthesia in Cats Undergoing Corneal and Lens Surgery. Animals (Basel) 2023; 13:ani13010170. [PMID: 36611778 PMCID: PMC9817947 DOI: 10.3390/ani13010170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
The aims of the study included evaluating the effects of levobupivacaine combined with cisatracurium on akinesia and mydriasis when administered by peribulbar injection, and evaluating if the chosen dose of cisatracurium is enough to avoid the use of systemic neuromuscular blockade in cats. The animals were divided into four groups as follows: group L received 1.25 mg kg-1 levobupivacaine administered by peribulbar injection; group LC received the same dose of levobupivacaine combined with 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group C received 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group GC received 0.01 mg kg-1 of cisatracurium intravenously. Physiological variables, intraocular pressure, akinesia, and mydriasis were measured before and up to 30 min after peribulbar injection. The onset of akinesia, duration of akinesia, and train of four (TOF) were evaluated. Physiological variables remained in the physiological range in all groups. Effective akinesia and mydriasis were observed in all groups. The (TOF) was 0.9 in all groups. Throughout the study was observed in group LC a shortened onset of akinesia and a prolonging its duration. The peribulbar injection of cisatracurium and levobupivacaine provided effective akinesia and mydriasis, and shortened the onset of akinesia while prolonging its duration.
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Affiliation(s)
- Giovanna L. Costa
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Via del Taglio 10, 43126 Parma, Italy
| | - Claudia Interlandi
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
- Correspondence: ; Tel.: +39(0)90-676-6758
| | - Filippo Spadola
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Sheila Fisichella
- Evidensia Veterinarhuset Sundsvall, Regementsvagen 9, 85238 Sundsvall, Sweden
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Bernadette Nastasi
- École Nationale Vétérinaire d’Alfort Unité d’anesthésie et reanimation, Pôle anesthésie et réanimation, Urgences et Soins Intensives 7, Av Du Général de Gaulle, 94700 Maisons-Alfort, France
| | - Daniele Macrì
- Zooprophylactic Institute, Via Gino Marinuzzi 3, 90100 Palermo, Italy
| | | | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
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Rocuronium versus dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: A double blind randomized placebo controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abu Elyazed MM, Abdelghafar MS, Mogahed MM, Nassif MA. The effect of adding cisatracurium versus hyaluronidase to levobupivacaine and lidocaine mixture in single injection peribulbar block for cataract surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mohamed M. Abu Elyazed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
| | | | - Mona Mohamed Mogahed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
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Hafez M, Fahim MR, Abdelhamid MHE, Youssef MMI, Salem AS. The effect of adding dexmedetomidine to local anesthetic mixture for peribulbar block in vitreoretinal surgeries. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mohamed Hafez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Faculty of Medicine Cairo University, Egypt
| | - Mona Raafat Fahim
- Department of Anesthesiology, Research Institute of Ophthalmology, Egypt
| | | | | | - Abeer Samir Salem
- Department of Anesthesiology, Research Institute of Ophthalmology, Egypt
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Ghanem MT, Tawfeek MA. Adding low dose rocuronium to local anesthetic mixture: Effect on quality of peribulbar blockade for vitreoretinal surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abdelhamid AM, Mahmoud A, Abdelhaq MM, Yasin HM, Bayoumi A. Dexmedetomidine as an additive to local anesthetics compared with intravenous dexmedetomidine in peribulbar block for cataract surgery. Saudi J Anaesth 2016; 10:50-4. [PMID: 26952175 PMCID: PMC4760042 DOI: 10.4103/1658-354x.169475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: No studies compared parenteral dexmedetomidine with its use as an adjuvant to ophthalmic block. We compared between adding dexmedetomidine to bupivacaine in peribulbar block and intravenous (IV) dexmedetomidine during peribulbar block for cataract surgery. Materials and Methods: A prospective, randomized, double-blind study on 90 patients for cataract surgery under peribulbar anesthesia. Study included three groups; all patients received 10 ml of peribulbar anesthesia and IV infusion of drugs as follows: Group I: Received a mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) + 150 IU hyaluronidase + IV infusion of normal saline, Group II: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + dexmedetomidine 50 μg (1 ml) +150 IU hyaluronidase + IV infusion of normal saline and Group III: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) +150 IU hyaluronidase + IV dexmedetomidine 1 μg/kg over 10 min; followed by 0.4 μg/kg/h IV infusion. We recorded onset, duration of block, Ramsay Sedation Score, intra-ocular pressure (IOP), hemodynamics, and adverse effects. Results: There was a significant decrease in the onset of action and increase in the duration of block in Group II as compared with the Group I and Group III. Mean Ramsay Sedation Score was higher in Group III. The IOP showed a significant decrease in Group II and Group III 10 min after injection (P < 0.01). Heart rate showed a significant decrease in Group III in comparison with the two other groups (P < 0.05). Only two patients in Group III developed bradycardia. Conclusion: Dexmedetomidine as an additive shortens onset time, prolong block durations and significantly decreases the IOP with minimal side effects. IV dexmedetomidine, in addition, produces intra-operative sedation with hemodynamic stability.
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Affiliation(s)
- A M Abdelhamid
- Department of Anesthesia, Faculty of Medicine, Benha University, Benha, Egypt
| | - Aaa Mahmoud
- Department of Anesthesia, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - M M Abdelhaq
- Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt
| | - H M Yasin
- Department of Anesthesia, Faculty of Medicine, Al Fayoum University, Faiyum, Egypt
| | - Asm Bayoumi
- Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
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Channabasappa SM, Shetty VR, Dharmappa SK, Sarma J. Efficacy and safety of dexmedetomidine as an additive to local anesthetics in peribulbar block for cataract surgery. Anesth Essays Res 2015; 7:39-43. [PMID: 25885718 PMCID: PMC4173478 DOI: 10.4103/0259-1162.113987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: We evaluated the effect of adding dexmedetomidine to lidocaine and bupivacaine for peribulbar block in two different doses. The primary endpoints were the onset and duration of corneal anesthesia, globe akinesia, and duration of analgesia. Materials and Methods: A randomized controlled clinical trial was conducted on 90 ASA I-II patients scheduled for elective cataract surgery under peribulbar anesthesia. Patients were randomly allocated to one of three groups of 30 each; group C (control) received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine; group D50 received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine and 50 ug of dexmedetomidine; and group D25 received 3 ml of 2% lidocaine with 3 ml of 0.5% bupivacaine and 25 μg of dexmedetomidine. Results: The onset of corneal anesthesia and globe akinesia was significantly shorter in group D50 (P < 0.001) as compared to group C; however, in Group D25 onset of corneal anesthesia was significantly faster, but not onset of globe akinesia (P = 0.45). The duration of corneal anesthesia and globe akinesia was significantly longer (P < 0.001) in both Group D50 and Group D25 in comparison to Group C. Decrease in IOP was observed in both group D50 and group D25 at 5 minutes and 10 minutes following peribulbar block which was significant (P < 0.05) compared to group C. Conclusion: Addition of dexmedetomidine to lidocaine and bupivacaine in peribulbar block shortens the onset time and prolongs the duration of the block and postoperative analgesia. It also provides sedation which enables full cooperation and potentially better operating conditions.
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Affiliation(s)
| | - Vijaya R Shetty
- Department of Ophthalmology, KVG Medical College and Hospital, Karnataka, India
| | | | - Jahanabi Sarma
- Department of Anaesthesiology, KVG Medical College and Hospital, Karnataka, India
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Dong J, Gao L, Lu W, Xu Z, Zheng J. Pharmacological interventions for acceleration of the onset time of rocuronium: a meta-analysis. PLoS One 2014; 9:e114231. [PMID: 25460931 PMCID: PMC4252114 DOI: 10.1371/journal.pone.0114231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/05/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rocuronium is an acceptable alternative when succinylcholine is contraindicated for facilitating the endotracheal intubation. However, the onset time of rocuronium for good intubation condition is still slower than that condition of succinylcholine. This study systematically investigated the most efficacious pharmacological interventions for accelerating the onset time of rocuronium. METHODS Medline, Embase, Cochrane Library databases, www.clinicaltrials.gov, and hand searching from the reference lists of identified papers were searched for randomized controlled trials comparing drug interventions with placebo or another drug to shorten the onset time of rocuronium. Statistical analyses were performed using RevMan5.2 and ADDIS 1.16.5 softwares. Mean differences (MDs) with their 95% confidence intervals (95% CIs) were used to analyze the effects of drug interventions on the onset time of rocuronium. RESULTS 43 randomized controlled trials with 2,465 patients were analyzed. The average onset time of rocuronium was 102.4±24.9 s. Priming with rocuronium [Mean difference (MD) -21.0 s, 95% confidence interval (95% CI) (-27.6 to -14.3 s)], pretreatment with ephedrine [-22.3 s (-29.1 to -15.5 s)], pretreatment with magnesium sulphate [-28.2 s (-50.9 to -5.6 s)] were all effective in reducing the onset time of rocuronium. Statistical testing of indirect comparisons showed that rocuronium priming, pretreatment with ephedrine, and pretreatment with magnesium sulphate had the similar efficacy. CONCLUSION Rocuronium priming, pretreatment with ephedrine, and pretreatment with magnesium sulphate were all effective in accelerating the onset time of rocuronium, and furthermore their efficacies were similar. Considering the convenience and efficacy, priming with rocuronium is recommended for accelerating the onset time of rocuronium. However, more strict clinical trials are still needed to reach a more solid conclusion due to the large heterogeneities exist among different studies.
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Affiliation(s)
- Jing Dong
- Department of Anesthesiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingqi Gao
- Department of Anesthesiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenqing Lu
- Department of Anesthesiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zifeng Xu
- Department of Anesthesiology, International Peace Maternal and Child Health Hospital, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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