The goal of the study is to compare the duration of analgesia in patients undergoing forearm or hand surgery with a supraclavicular brachial plexus block, who receive either iv dexmedetomidine or placebo.
Most surgical interventions on the forearm and the hand in Valais Hospital are performed under regional anesthesia. This ensures intraoperative patient comfort and reduces pain during the first 6 to 12 postoperative hours. A very common strategy to provide anesthesia of the arm is to inject local anesthetics in the region over the clavicle around the brachial plexus. This "supraclavicular brachial plexus block" is routinely performed in Valais Hospital and is always done under ultrasound guidance. A drawback of locoregional anesthesia is the recurrence of pain once the effect of the block wears off after approximately 6 to 8 hours. This phenomenon is called rebound pain. It and can be very severe and debilitating, can significantly impact postoperative recovery and may also preclude ambulatory surgery as well as early mobilization and physiotherapy. Therefore, strategies that prolong the analgesic effect of locoregional anesthesia are warranted. Dexmedetomidine is a selective α2-adrenoceptor agonists with sedative and analgesic properties. It has been shown to prolong the analgesic duration of local anesthetics when administered intravenously. However, the association of dexmedetomidine with long-acting local anesthetics for supraclavicular brachial plexus block has not been systematically investigated.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
100
After completion of supraclavicular brachial plexus block patients will receive intravenous dexmedetomidine 1 mcg/kg
Hopital du Valais
Sion, Switzerland
duration of analgesia
time in minutes from end of injection of local anesthetic till first analgesic request
Time frame: 24 hours on day of surgery
Duration of motor block
time in minutes from completion of locoregional anesthesia and the moment the patient can again mobilize the arm
Time frame: 24 hours on day of surgery
Duration of sensory block
time in minutes from completion of locoregional anesthesia and the moment the patient regains sensation of the arm
Time frame: 24 hours on day of surgery
Pain scores at rest
Pain scores at rest on numeric scale, 0=no pain at all to 10=worst pain imaginable
Time frame: 4, 24, 48 hours postoperatively
Pain scores on movement
Pain scores on movement, on numeric scale, 0=no pain at all to 10=worst pain imaginable
Time frame: 4, 24, 48 hours postoperatively
Cumulative amount of opiate analgesic medication consumed
in intravenous morphine equivalents (mg)
Time frame: 24, 48 hours postoperatively
Patient satisfaction
on 4 point Likert scale: dissatisfied / neutral / satisfied / extremely satisfied
Time frame: 7 days postoperatively
Total number of dexmedetomidine-related side effects
Total number of dexmedetomidine-related side effects, in particular bradycardia and hypotension
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 24 hours postoperatively
Dexmedetomidine-related side effects
Number and % of patients who experience at least one dexmedetomidine-related side effect
Time frame: 24 hours postoperatively
Opioid-related side effect
Number and % of patients who experience at least one opioid-related side effect
Time frame: 24 hours postoperatively