the Analgesic Duration of Dexmedetomidine Compared to Dexamethasone as Adjuncts to Single Shot Interscalene Block
Condition: Opioid Use, Unspecified
Study type: Interventional
Phase: Phase 4

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Ropivacaine; Dexmedetomidine; Dexamethasone
Intervention type(s): Drug; Drug; Drug
Intervention description(s): local anesthetics adjuvants. Ropivacaine 0.5% 20ml. pre-operative single shot interscalene nerve block under ultrasound guidance and peripheral nerve stimulation in patients undergoing ambulatory shoulder surgery; local anesthetics adjuvants. 75mcg of dexmedetomidine. pre-operative single shot interscalene nerve block under ultrasound guidance and peripheral nerve stimulation in patients undergoing ambulatory shoulder surgery; local anesthetics adjuvants. 4mg dexamethasone. pre-operative single shot interscalene nerve block under ultrasound guidance and peripheral nerve stimulation in patients undergoing ambulatory shoulder surgery
Other intervention name(s): anesthetics; anesthetics; anesthetics
Intervention MeSH terms: Dexamethasone; Dexmedetomidine; Ropivacaine; Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment
Keywords: post operative pain, Dexmedetomidine, Regional anesthesia