The Effect of Dexmedetomidine as an Adjuvant for Lower Limb Nerve Blocks

Study Overview
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Brief Summary
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Peripheral nerve block has been recommended as the technique for postoperative pain management because it provides equivalent analgesia but with fewer adverse effects than either systemic or epidural analgesia. The use of clonidine, a partial α2 adrenoceptor agonist, has been reported to prolong the duration and analgesia in peripheral nerve blockade. Dexmedetomidine is a more selective and shorter-acting α2 adrenergic receptor.However, its use in femoral and common peroneal nerve blocks has not been described. In this study, we investigated the effect of adding dexmedetomidine as additive in femoral and common peroneal nerve blocks for postoperative analgesia. Patients, diagnosed as oromaxillofacial tumor and undergoing elective free fibular or anterolateral thigh flap reconstruction, were divided into two groups in a randomized, double-blind fashion. In Group Ropivacaine (Group R), nerve blocks were administered with 0.3% ropivacaine. In Group Ropivacaine + Dexmedetomidine (Group RD), nerve blocks were administered with 0.3% ropivacaine and 50 μg dexmedetomidine.The primary endpoints were the onset time and duration of sensory blocks. The secondary endpoints were heart rate, blood pressure, SpO2, sedation level, the duration of motor blocks.

Detailed Description
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Peripheral nerve block has been recommended as the technique for postoperative pain management because it provides equivalent analgesia but with fewer adverse effects than either systemic or epidural analgesia. The use of clonidine, a partial α2 adrenoceptor agonist, has been reported to prolong the duration and analgesia in peripheral nerve blockade. Dexmedetomidine is a more selective and shorter-acting α2 adrenergic receptor.However, its use in femoral and common peroneal nerve blocks has not been described. In this study, we investigated the effect of adding dexmedetomidine as additive in femoral and common peroneal nerve blocks for postoperative analgesia. Patients, diagnosed as oromaxillofacial tumor and undergoing elective free fibular or anterolateral thigh flap reconstruction, were divided into two groups in a randomized, double-blind fashion. For patients with free fibular flaps harvested, femoral nerve block and common peroneal nerve with ropivacaine were administered. For patients with anterolateral thigh flaps harvested, femoral nerve block with ropivacaine was administered.In Group R, nerve blocks were administered with 0.3% ropivacaine. In Group RD, nerve blocks were administered with 0.3% ropivacaine and 50 μg dexmedetomidine.The primary endpoints were the onset time and duration of sensory blocks. The secondary endpoints were heart rate, blood pressure, pulse oxygen saturation (SpO2), sedation level, the duration of motor blocks.

Official Title
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The Effect of Dexmedetomidine as an Adjuvant for Lower Limb Nerve Blocks Following Oromaxillofacial Reconstruction

Conditions
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Free Flap Reconstruction

Intervention / Treatment
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* Drug: 0.3% ropivacaine and 50 μg dexmedetomidine
* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of oral and maxillofacial tumor. Undergoing microsurgical oromandibular reconstruction with free fibular flaps or anterolateral thigh flaps. Greater than 18 years old. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: True allergy to local anesthetics or dexmedetomidine. History of chronic pain on opioids within the last 12 months. Specific mental health issues such as schizophrenia or bipolar disorder. Patients who are pregnant.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Group R<br>Nerve blocks were administered with 0.3% ropivacaine without dexmedetomidine. | Drug: Ropivacaine<br>* Nerve blocks were administered with 0.3% ropivacaine.<br>|
| Experimental: Group RD<br>Nerve blocks were administered with 0.3% ropivacaine and 50 μg dexmedetomidine. | Drug: 0.3% ropivacaine and 50 μg dexmedetomidine<br>* Nerve blocks were administered with 0.3% ropivacaine and 50 μg dexmedetomidine.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the duration of sensory blocks | The duration of sensory block was defined as the time interval between the end of ropivacaine administration and the pain score up to 5. | The duration of sensory blocks was recorded up to 48 hours after injection. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sedation level | Sedation level was assessed using visual scale. | every 5 minutes until 30 minutes after injection, and then every 60 minutes up to 48 hours | 
| heart rate | If the heart rate is lower 50 beat/minute, atropine was administered. | every 5 minutes until 30 minutes after injection, and then every 60 minutes up to 48 hours |