Dexmedetomidine as Adjuvant in Erector Spinae Plane Block After Shoulder Arthroscopy
Condition: Arthroscopy; Erector Spinae Plane Block; Analgesia
Study type: Interventional

Summary: 
      The aim of this study is to evaluate the effect of adding dexmedetomidine as an adjuvant to
      bupivacaine in ultrasound (US) guided erector spinae plane block (ESPB) for managing acute
      postoperative pain in patients undergoing shoulder arthroscopy.
    

Detailed description: 
      Shoulder arthroscopy is a common procedure done is orthopedics for many surgical indications
      as rotator cuff tears, stiffness and instability. This procedure has a well - documented
      postoperative pain. To improve the outcome after surgery, effective pain control is needed.

      There are many postoperative pain management modalities after shoulder arthroscopy including
      non-steroidal anti-inflammatory drugs, intraarticular injection, regional nerve blocks,
      patient controlled analgesia and cryotherapy.

      The erector spinae plane block (ESPB) is one of the emerging regional techniques for managing
      postoperative pain. ESPB has been used successfully in many surgeries such as mastectomy,
      thoracotomies , percutaneous nephrolithotomies, lumbar fusions, hernia repair, cesarean
      delivery and even in total hip arthroplasty .

      ESPB has been successfully used to treat chronic shoulder pain, and the local anesthetic
      spread was reported to reach the level of C3 when it was performed at T2.

      Dexmedetomidine is a very selective α2 adrenoceptor agonist that is tenfold more selective
      than clonidine. It is a highly flexible medication in anesthetic practice, finding use in an
      expanding range of clinical circumstances.
    

Intervention name(s): Erector Spinae Plane block without Dexmedetomidine group; Erector Spinae Plane block with Dexmedetomidine group
Intervention type(s): Procedure; Procedure
Intervention description(s): Block will be performed with an ultrasound machine (Philips CX50 Extreme edition). A 2-5 MH2 curved probe will be positioned transversely to visualize the lateral tip of thoracic vertebrae2 transverse Process. Before surgery with patients in sitting position, the transducer will be positioned longitudinally 3 cm lateral to the thoracic vertebrae2 spinous process. The trapezius, rhomboid major, and erector spinae muscles will be revealed superficial to the shadow of the hyperechoic transverse process. Then, 3ml lidocaine 2% will be used to anesthetize the skin. Using a 20-gauge block needle put in-plane in a cephalad-to-caudad orientation to position the tip into the fascial plane on the deep (anterior) side of the erector spinae muscle, 19 ml of bupivacaine 0.25% + 1 mL saline will be injected. The needle tip's placement will be confirmed by observable fluid spread lifting the erector spinae muscle away from the transverse process's bony shadow.; Block will be performed with an ultrasound machine (Philips CX50 Extreme edition). A 2-5 MH2 curved probe will be positioned transversely to visualize the lateral tip of thoracic vertebrae2 transverse Process. Before surgery with patients in sitting position, the transducer will be positioned longitudinally 3 cm lateral to the thoracic vertebrae2 spinous process. The trapezius, rhomboid major, and erector spinae muscles will be revealed superficial to the shadow of the hyperechoic transverse process. Then, 3ml lidocaine 2% will be used to anesthetize the skin. Using a 20-gauge block needle put in-plane in a cephalad-to-caudad orientation to position the tip into the fascial plane on the deep (anterior) side of the erector spinae muscle, 19 ml of bupivacaine 0.25% + 1 mL dexmedetomidine 0.5 µg/kg will be injected. The needle tip's placement will be confirmed by observable fluid spread lifting the erector spinae muscle away from the transverse process's bony shadow.
Intervention MeSH terms: Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment