Opioid Use, Unspecified Clinical Trial
Official title:
Double Blinded Randomized Controlled Study Evaluating the Analgesic Duration of Dexmedetomidine Compared to Dexamethasone as Adjuncts to Single Shot Interscalene Block in Patients Undergoing Ambulatory Shoulder Surgery
The purpose of the study is to determine if perineural dexmedetomidine can provide increased prolongation of analgesia when compared to perineural dexamethasone in patients receiving regional block for shoulder surgery. If so, dexmedetomidine may serve as a superior adjunct to peripheral nerve blocks in a rapidly evolving, ambulatory-centered surgical setting.
Currently, the most commonly employed adjunct to peripheral nerve blockade is perineural
dexamethasone. In general, at the doses used in regional anesthesia, dexamethasone has a
minimal side effect profile. However, while it has been shown to increase duration of
analgesia, there have been concerns regarding its neurotoxicity in animal studies. In
addition, dexamethasone has the potential to cause hyperglycemia in patients with impaired
glucose metabolism as well as perineal pain and pruritis when administered peripherally.
Dexmedetomidine is a highly selective alpha-2 agonist that is commonly used in patients
undergoing anesthesia or requiring sedation in a non-operative setting. As a peripherally
administered medication, it has both sedating and analgesic properties, as well as the added
benefit of avoidance of respiratory depression. Although it can rarely produce cardiac
depression at high doses, its side effect profile is otherwise minimal and is generally very
well tolerated by most patients. When administered peripherally, dexmedetomidine has most
commonly been associated with side effects such as hypotension, respiratory depression, and
bradycardia - although all at significantly higher doses than planned in our study. The safe
use of perineural dexmedetomidine together with local anesthetics has been described on
numerous occasions. Nevertheless, although it has been shown to potentiate peripheral nerve
blockade and prolong duration of analgesia in various studies , it remains rarely used as an
adjunct to regional anesthesia.
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