Surgery
Conditions
Keywords
locoregional anesthesia, postoperative analgesia, hand surgery, dexmedetomidine
Brief summary
The goal of the study is to compare the duration of analgesia in patients undergoing forearm or hand surgery with a supraclavicular brachial plexus block, who receive either iv dexmedetomidine or placebo.
Detailed description
Most surgical interventions on the forearm and the hand in Valais Hospital are performed under regional anesthesia. This ensures intraoperative patient comfort and reduces pain during the first 6 to 12 postoperative hours. A very common strategy to provide anesthesia of the arm is to inject local anesthetics in the region over the clavicle around the brachial plexus. This supraclavicular brachial plexus block is routinely performed in Valais Hospital and is always done under ultrasound guidance. A drawback of locoregional anesthesia is the recurrence of pain once the effect of the block wears off after approximately 6 to 8 hours. This phenomenon is called rebound pain. It and can be very severe and debilitating, can significantly impact postoperative recovery and may also preclude ambulatory surgery as well as early mobilization and physiotherapy. Therefore, strategies that prolong the analgesic effect of locoregional anesthesia are warranted. Dexmedetomidine is a selective α2-adrenoceptor agonists with sedative and analgesic properties. It has been shown to prolong the analgesic duration of local anesthetics when administered intravenously. However, the association of dexmedetomidine with long-acting local anesthetics for supraclavicular brachial plexus block has not been systematically investigated.
Interventions
DRUGDexmedetomidine
After completion of supraclavicular brachial plexus block patients will receive intravenous dexmedetomidine 1 mcg/kg
Sponsors
Hôpital du Valais
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
dexmedetomidine or placebo prepared by Lausanne University Hospital Pharmacy
Intervention model description
Patients undergoing forearm or hand surgery under supraclavicular brachial plexus block, receiving either additional intravenous dexmedetomidine or placebo
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Patients undergoing elbow, forearm or hand surgery under supraclavicular brachial plexus block Patients who are ASA physical status I-III
Exclusion criteria
* Patient refusal * ASA physical status IV * History of hypersensitivity or intolerance to dexmedetomidine * History of hypersensitivity or intolerance to dexamethasone * History of hypersensitivity or intolerance to local anesthetics * History of recent (\< 1 year) cerebrovascular insult * Second or third degree heart block * Uncontrolled hypotension * Conditions contraindicating supraclavicular brachial plexus block: neurological deficit or neuropathy of the arm, severe hepatic dysfunction (Child B and C), coagulopathy, malignancy or infection in the area above the clavicle * Chronic opioid use * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| duration of analgesia | 24 hours on day of surgery | time in minutes from end of injection of local anesthetic till first analgesic request |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of sensory block | 24 hours on day of surgery | time in minutes from completion of locoregional anesthesia and the moment the patient regains sensation of the arm |
| Pain scores at rest | 4, 24, 48 hours postoperatively | Pain scores at rest on numeric scale, 0=no pain at all to 10=worst pain imaginable |
| Pain scores on movement | 4, 24, 48 hours postoperatively | Pain scores on movement, on numeric scale, 0=no pain at all to 10=worst pain imaginable |
| Cumulative amount of opiate analgesic medication consumed | 24, 48 hours postoperatively | in intravenous morphine equivalents (mg) |
| Duration of motor block | 24 hours on day of surgery | time in minutes from completion of locoregional anesthesia and the moment the patient can again mobilize the arm |
| Total number of dexmedetomidine-related side effects | 24 hours postoperatively | Total number of dexmedetomidine-related side effects, in particular bradycardia and hypotension |
| Dexmedetomidine-related side effects | 24 hours postoperatively | Number and % of patients who experience at least one dexmedetomidine-related side effect |
| Opioid-related side effect | 24 hours postoperatively | Number and % of patients who experience at least one opioid-related side effect |
| Patient satisfaction | 7 days postoperatively | on 4 point Likert scale: dissatisfied / neutral / satisfied / extremely satisfied |
Countries
Switzerland
Outcome results
None listed