Document Type : Research articles

Authors

1 Anesthesiologist, Pain fellowship. Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Anesthesiologist, Cardiac Anesthesiology fellowship. Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

3 Anesthesiologist. Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Abstract

Background: Pain control is one of the most important issues in femoral fractures. One of the most effective methods is the fascia iliaca compartment block.
Objectives: The aim of this study was to compare the efficacy of the addition of dexmedetomidine to bupivacaine on the quality of ultrasound guided blockade of the fascia iliaca compartment in adults undergoing femoral shaft fracture surgery.
Methods: This study was a double-blind clinical trial. We studied 60 adults who were hospitalized for a femoral shaft fracture. The patients were divided into two equal groups receiving either bupivacaine alone or bupivacaine and dexmedetomidine for compartment blockade of the iliac fascia. Group allocation was based on the method of randomization from concealed envelopes. Primary outcomes were pain intensity, sedation and analgesic consumption assessed at 1, 2, 6 and 24 hours after surgery in two groups. Data were analyzed using SPSS software.
Results: Pain intensity was lower in the dexmedetomidine group 1, 2, 6 and 24 hours after surgery (p<0.05). The sedation score was also higher in the dexmedetomidine group 6 and 24 hours after surgery (p<0.05). The dose of analgesics used by the dexmedetomidine group was significantly lower 6 and 24 h after treatment. No hypotension, respiratory depressionand bradycardia occurred in the patients participating in this study.
Conclusion: The addition of dexmedetomidine to bupivacaine during ultrasound-guided blockade of the fascia-iliac compartment is associated with reduced pain intensity and improved sedation in patients undergoing femoral fracture surgery.

Keywords

  1. Wagner DS, Brummett CM. Dexmedetomidine: as safe as safe can be. Semin Anesth Perioperat Med Pain. 2006;25(2):77-83. doi: 10.1053/j.sane.2006.02.003.
  2. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109(3):502-11. doi: 10.1097/ALN.0b013e318182c26b. [PubMed: 18719449].
  3. Brummett CM, Padda AK, Amodeo FS, Welch KB, Lydic R. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 2009;111(5):1111-19. doi: 10.1097/ALN.0b013e3181bbcc26. [PubMed: 19858875].
  4. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50(2):222-27. doi: 10.1111/j.1399-6576.2006.00919.x. [PubMed: 16430546].
  5. Esmaoglu A, Mizrak A, Akin A, Turk Y, Boyaci A. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia. Eur J Anaesthesiol. 2005;22(6):447-51. doi: 10.1017/s0265021505000761. [PubMed: 15991508].
  6. Khosravi F, Sadeghi N, Jarineshin H. The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal. Eur J Clin Pharmacol. 2020;76(7):923-28. doi: 10.1007/s00228-020-02870-8. [PubMed: 32318749].
  7. Khosravi F, Sharifi M, Jarineshin H. Comparative Study of Fentanyl vs Dexmedetomidine as Adjuvants to Intrathecal Bupivacaine in Cesarean Section: A Randomized, Double-Blind Clinical Trial. J Pain Res. 2020;13:2475-82. doi: 10.2147/JPR.S265161. [PubMed: 33116789].
  8. Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013;110(3):438-42. doi: 10.1093/bja/aes400. [PubMed: 23161360].
  9. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013;110(6):915-25. doi: 10.1093/bja/aet066. [PubMed: 23587874].
  10. Yektaş A, Gümüş F, Algol A. Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via an anterior approach. Braz J Anesthesiol. 2015;65(5):371-8. doi: 10.1016/j.bjane.2014.01.003. [PubMed: 26323736].
  11. El-Rahmawy GF, Hayes SMS. Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery. Egypt J Anaesth. 2013;29(2):137-42. doi: 10.1016/j.egja.2012.10.005.
  12. Li Y, Geng J, Wen L, Chen J, Wu Z. Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery. Saudi J Anaesth. 2019;13(2):100-5. doi: 10.4103/sja.SJA_533_18. [PubMed: 31007654].
  13. Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2014;30(1):36-40. doi: 10.4103/0970-9185.125701. [PubMed: 24574591].
  14. Ammar AS, Mahmoud KM. 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 Anaesth. 2012;6(2):109-14. doi: 10.4103/1658-354X.97021. [PubMed: 22754434].
  15. Halder S, Das A, Mandal D, Chandra M, Ray S, Biswas MR, et al. Effect of different doses of dexmedetomidine as adjuvant in the bupivacaine-induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study. J Clin Diagn Res. 2014;8(11):1-6. doi: 10.7860/JCDR/2014/9670.5118. [PubMed: 25584237].
  16. Helal SM, Eskandr AM, Gaballah KM, Gaarour IS. Effects of perineural administration of dexmedetomidine in combination with bupivacaine in a femoral-sciatic nerve block. Saudi J Anaesth. 2016;10(1):18-24. doi: 10.4103/1658-354X.169469. [PubMed: 26955305].
  17. Attia J, Zein A. Effects of Adjuvant in Potentiating the Analgesic Effect of Fascia Iliaca Compartment Block. J Anesth Surg. 2017;4(2):86-92. doi: 10.15436/2377-1364.17.083.
  18. Hua X, Hu Y, Chen D, Xiao Y, Luo L. Efficacy and safety of ultrasound-guided fascia iliaca compartment block using dexmedetomidine combined with ropivacaine in aged patients undergoing hip replacement. Int J Clin Exp Med. 2017;10(12):16484-91.
  19. Kundra S, Singh B, Singh MR, Sood D, Roy R, Singh T. RCT on the Effect of Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound-Guided Fascia Illiaca Block for Postoperative Analgesia Following Hemi-Arthroplasty. J Clin Diagn Res. 2019;13(6):1-4. doi: 10.7860/JCDR/2019/41237.12900.