Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair.

Abstract

PURPOSE:

Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair.

METHODS:

Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1 ml (100 μg) of DEX and 8 ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1 ml of normal saline and 8 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48 h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48 h, postoperatively.

RESULTS:

Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18 h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48 h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48 h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7 h > 9.4 h, p = 0.006).

CONCLUSIONS:

Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48 h postoperatively, with delayed rebound pain.

LEVEL OF EVIDENCE:

I.

TRIAL REGISTRATION:

2013-112, ClinicalTrials.gov Identifier: NCT02766556.

• Authors: Jung-Taek Hwang, Ji Su Jang, Jae Jun Lee, Dong-Keun Song, Han Na Lee, Do-Young Kim, Sang-Soo Lee, Sung Mi Hwang, Yong-Been Kim, Sanghyeon Lee
• Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA (Knee Surg Sports Traumatol Arthrosc) Vol. 28 Issue 7 Pg. 2343-2353 (Jul 2020) ISSN: 1433-7347 [Electronic] Germany
• PMID: 31773201 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• CXCL8 protein, human
• Hypnotics and Sedatives
• IL1B protein, human
• IL6 protein, human
• Interleukin-1beta
• Interleukin-6
• Interleukin-8
• Dexmedetomidine
• Ropivacaine

Topics

• Adult
• Aged
• Anesthetics, Local
• Arthroscopy
• Body Mass Index
• Brachial Plexus Block
• Dexmedetomidine (administration & dosage)
• Double-Blind Method
• Female
• Humans
• Hypnotics and Sedatives (administration & dosage)
• Interleukin-1beta (metabolism)
• Interleukin-6 (metabolism)
• Interleukin-8 (metabolism)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pain, Postoperative (therapy)
• Patient Satisfaction
• Postoperative Period
• Ropivacaine (administration & dosage)
• Rotator Cuff (surgery)
• Rotator Cuff Injuries (surgery)
• Visual Analog Scale