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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

18.02.2021 | Reports of Original Investigations

Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial

verfasst von: Daniel Rodrigues, MD, FRCPC, Ryan J. J. Amadeo, MD, FRCPC, Scott Wolfe, MD, FRCPC, Linda Girling, BScHons, Faylene Funk, RRT, Kelsi Fidler, BA, Holly Brown, BHK, Jeff Leiter, PhD, Jason Old, MD, FRCSC, Peter MacDonald, MD, FRCSC, Brenden Dufault, MSc, Thomas C. Mutter, MD, FRCPC, MSc

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 6/2021

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Abstract

Purpose

Both intravenous dexamethasone and dexmedetomidine prolong the analgesic duration of interscalene blocks (ISB) after arthroscopic shoulder surgery. This study compared their relative effectiveness and the benefit of their use in combination.

Methods

This single-centre, double-blinded, parallel three-group superiority trial randomized 198 adult patients undergoing ambulatory arthroscopic shoulder surgery. Patients received preoperative ISB with 30 mL 0.5% bupivacaine and 50 µg dexmedetomidine or 4 mg dexamethasone or both of these agents as intravenous adjuncts. The primary outcome was analgesic block duration. Secondary outcomes included the quality of recovery 15 score (range: 0–150) on day 1 and postoperative neurologic symptoms in the surgical arm.

Results

Block durations (n = 195) with dexamethasone (median [range], 24.5 [2.0–339.5] hr) and both adjuncts (24.0 [1.5-157.0] hr) were prolonged compared with dexmedetomidine (16.0 [1.5–154.0] hr). When analyzed by linear regression after an unplanned log transformation because of right-skewed data, the corresponding prolongations of block duration were 59% (95% confidence interval [CI], 28 to 97) and 46% (95% CI, 18 to 80), respectively (both P < 0.001). The combined adjuncts were not superior to dexamethasone alone (-8%; 95% CI, -26 to 14; P = 0.42). Median [IQR] quality of recovery 15 scores (n = 197) were significantly different only between dexamethasone (126 [79–149]) and dexmedetomidine (118.5 [41–150], P = 0.004), but by an amount less than the 8-point minimum clinically important difference.

Conclusion

Dexamethasone is superior to dexmedetomidine as an intravenous adjunct for prolongation of bupivacaine-based ISB analgesic duration. There was no additional benefit to using both adjuncts in combination.

Trial registration

www.clinicaltrials.gov(NCT03270033); registered 1 September 2017.

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Titel: Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial
verfasst von: Daniel Rodrigues, MD, FRCPC
Ryan J. J. Amadeo, MD, FRCPC
Scott Wolfe, MD, FRCPC
Linda Girling, BScHons
Faylene Funk, RRT
Kelsi Fidler, BA
Holly Brown, BHK
Jeff Leiter, PhD
Jason Old, MD, FRCSC
Peter MacDonald, MD, FRCSC
Brenden Dufault, MSc
Thomas C. Mutter, MD, FRCPC, MSc
Publikationsdatum: 18.02.2021
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 6/2021
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-021-01942-2

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Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial