Restricted accessResearch articleFirst published online 2018-2
Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries
Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far.
Methods:
The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 μg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 μg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours.
Results:
The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51).
Conclusion:
Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.1
McDonnellJGFinnertyOLaffeyJG. Stellate ganglion blockade for analgesia following upper limb surgery. Anaesthesia2011; 66: 611–614.
3.
KumarNThapaDGombarSet al. Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial. Anaesthesia2014; 69: 954–960.
4.
FritschGDanningerTAllerbergerKet al. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med2014; 39: 37–47.
5.
LinYNLiQYangRMet al. Addition of dexmedetomidine to ropivacaine improves cervical plexus block. Acta Anaesthesiol Taiwan2013; 51: 63–66.
6.
AmmarASMahmoudKM. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: a prospective randomized controlled trial. Saudi J Anaesth2012; 6: 109–114.
7.
MarhoferDKettnerSCMarhoferPet al. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth2013; 110: 438–442.
8.
AggarwalSAggarwalRGuptaP. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol2014; 30: 36–40.
9.
AbdallahFWBrullR. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth2013; 110: 915–925.
10.
SimJHYuHJKimST. The effects of different loading doses of dexmedetomidine on sedation. Korean J Anesthesiol2014; 67: 8–12.
GaumannDFosterAGriessenMet al. Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block. Anesth Analg1992; 75: 69–74.
13.
GastelPKallewaardJWZandenMet al. Stellate-ganglion block as a treatment for severe postmenopausal flushing. Climacteric2013; 16: 41–47.
14.
StamerUMMaierCGrondSet al. Tramadol in the management of post-operative pain: a double-blind, placebo- and active drug-controlled study. Eur J Anaesthesiol1997. 14: 646–654.
15.
MomeniMCrucittiMDe KockM. Patient-controlled Analgesia in the management of postoperative pain. Drugs2006; 66: 2321–2337.
16.
ParikhGPShahVRModiMPet al. The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy: a prospective randomized study. J Anaesthesiol Clin Pharmacol2011; 27: 481–484.
17.
CarneyJMcDonnellJGOchanaAet al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg2008; 107: 2056–2060.
18.
KakazuCZJulkaI. Stellate ganglion blockade for acute post operative upper extremity pain. Anesthesiology2005; 102: 1288–1289.
19.
BantelSTrappS. The role of autonomic nervous system in acute surgical pain processing: what do we know?Anaesthesia2011; 66: 541–544.
20.
MaundEMacDainCRiceSet al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systemic review. Br J Anaesth2011; 106: 292–297.
21.
KulkarniKRKadamAINamaziIJ. Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs. Indian J Anaesth2010; 54: 546–551.
22.
BrummettCMPaddaAKAmodeoFSet al. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology2009; 111: 1111–1119.
23.
GaumannDMBrunetPCJirounekP. Hyperpolarizing afterpotentials in C fibers and local anesthetic effects of clonidine and lidocaine. Pharmacology1994; 48: 21–29.
24.
DalleCSchneiderMClerqueFet al. Inhibition of the I(h) current in isolated peripheral nerve: a novel mode of peripheral antinociception?Muscle Nerve2001; 24: 254–261.
25.
TezukaMKitajimaTYamaguchiSet al. Addition of dexmedetomidine prolongs duration of vasodilation induced by sympathetic block with mepivacaine in dogs. Reg Anesth Pain Med2004; 29: 323–327.
26.
ChoiEMKimEMChungMHet al. Effects of ultrasound-guided stellate ganglion block on acute pain after arthroscopic shoulder surgery. Pain Physician2015; 18: 379–388.
27.
ThapaDAhujaVGombarS. Pain relief following shoulder arthroscopic in patients receiving stellate ganglion block – some more facts. Pain Physician2015; 18: 933–938.
28.
AbdallahFWDwynerTChanVWet al. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triple masked, placebo-controlled trial. Anesthesiology2016; 124: 683–695.
29.
KathuriaSGuptaSDhawanI. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth2015; 9: 148–154.
30.
DasAMajumdarSHalderSet al. Effect of dexmedetomidine as adjuvant in ropivacaine-induced supraclavicular brachial plexus block: a prospective, double-blinded and randomized controlled study. Saudi J Anaesth2014; 8: 72–77.
31.
AlmarakbiWAKakiAM. Addition of dexmedetomidine to bupivacaine in transversus abdominis plane block potentiates post-operative pain relief among abdominal hysterectomy patients: a prospective randomized controlled trial. Saudi J Anaesth2014; 8: 161–166.
32.
RevesJGGlassSALubarskyALet al. IV nonopioid anesthetics. In: MillerRD (ed.) Miller’s Anesthesia, 6th edn.Philadelphia, PA: Churchill Livingston Elsevier, 2005, pp. 317–378.
33.
KimYUCheongYKongGYet al. The prolongation of pulse transit time after a stellate ganglion block: an objective indicator of successful block. Pain Res Manag2015; 20: 305–308.
34.
GhaiAKaushikTKunduZSet al. Evaluation of new approach to ultrasound guided stellate ganglion block. Saudi J Anaesth2016; 10: 161–167.
35.
LeeMHKimKYSongJHet al. Minimal volume of local anesthetic required for an ultrasound-guided SGB. Pain Med2012; 13: 1381–1388.
36.
WeiKFeldmannREBrascherAKet al. Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in complex regional pain syndrome (CRPS): a pilot case series ad interim. Pain Med2014; 15: 2120–2127.
