A randomized comparison between interscalene block and dexmedetomidine for arthroscopic shoulder surgery
Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine.
Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block.
Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment.
Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon’s opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment.
Conclusion: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.
Fredrickson MJ, Ball CM, Dalgleish AJ. Analgesic effectiveness of a continuous versus single-injection interscalene block for minor arthroscopic shoulder surgery. Reg Anesth and Pain Med. 2010;35(1):28-33.
Lee HY, Kim SH, So KY, Kim DJ. Effects of interscalene brachial plexus block to intra-operative hemodynamics and postoperative pain for arthroscopic shoulder surgery. Korean J Anesthesiol. 2012;62(1):30. doi: https://www.doi.org/10.4097/kjae.2012.62.1.30.
Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth and Pain Med. 2008;33(3):253-8. doi: https://www.doi.org/10.1016/j.rapm.2007.10.011.
Gerlach AT, Dasta JF. Dexmedetomidine: an updated review. Ann Pharmacother. 2007;41(2):245-54. doi: https://www.doi.org/10.1345/aph.1H314.
Bajwa SJ, Kaur J, Singh A, Parmar SS, Singh G, Kulshrestha A et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth. 2012;56(2):123. doi: https://www.doi.org/10.4103/0019-5049.96303.
Halaszynski TM. Dexmedetomidine: A look at a promising new avenue of use. Saudi J Anaesth. 2012;6(2):104. doi: https://www.doi.org/10.4103/1658-354X.97019.
Hwang JT, Jang JS, Lee JJ, Song DK, Lee HN, Kim DY et al. Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28(7):2343-53. doi: https://www.doi.org/10.1007/s00167-019-05799-3.
Velázquez-Delgado E, Gaspar-Carrillo SP, Peña-Riveron AA, Mejía-Terrazas GE. Postoperative analgesia with dexmedetomidine in interscalene block. Comparative study. Revista Española de Anestesiología y Reanimación (English Edition). 2017;64(3):137-43. doi: https://www.doi.org/10.1016/j.redar.2016.07.005.
Lee JJ, Kim DY, Hwang JT, Song DK, Lee HN, Jang JS et al. Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2020:1-0. doi: https://www.doi.org/10.1007/s00167-020-06288-8.
Spence BC, Beach ML, Gallagher JD, Sites BD. Ultrasound‐guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia. 2011;66(6):509-14. doi: https://www.doi.org/10.1111/j.1365-2044.2011.06712.x.
Beecroft CL, Coventry DM. Anaesthesia for shoulder surgery. Continuing Education in Anaesthesia, Critical Care and Pain. 2008;8(6):193-8. doi: https://doi.org/10.1093/bjaceaccp/mkn040
Choi S, Kim T, Kwon YS, Kang H. Intra-operative effect of interscalene brachial plexus block to arthroscopic rotator cuff repair surgery. Int Orthop 2019;43(9):2117-24. doi: https://www.doi.org/10.1007/s00264-018-4199-x.
Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis. Indian Journal Anaesth. 2012;56(6):542. doi: https://www.doi.org/10.4103/0019-5049.104571.
Hamid MH. Intravenous dexmedetomidine infusion compared with that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. Anesth Essays Res. 2017;11(4):1070. doi: https://www.doi.org/10.4103/aer.AER_148_17.
Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg. 2015;120(5):1114-29. doi: https://www.doi.org/10.1213/ANE.0000000000000688.
Jung HS, Joo JD, Jeon YS, Lee JA, Kim DW, In JH et al. Comparison of an intraoperative infusion of dexmedetomidine or remifentanil on perioperative haemodynamics, hypnosis and sedation, and postoperative pain control. J Int Med Res. 2011;39(5):1890-9. doi: https://www.doi.org/10.1177/147323001103900533.
Singh A, Kelly C, O’Brien T, Wilson J, Warner JJ. Ultrasound-guided interscalene block anesthesia for shoulder arthroscopy: a prospective study of 1319 patients. J Bone Joint Surg. 2012;94(22):2040-6. doi: https://www.doi.org/10.2106/JBJS.K.01418.