Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block
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Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block. / Andersen, Jakob Hessel; Jaeger, Pia; Grevstad, Ulrik; Estrup, Stine; Geisler, Anja; Vilhelmsen, Frederik; Dahl, Jorgen B; Laier, Gunnar Hellmund; Ilfeld, Brian M; Mathiesen, Ole.
In: Regional Anesthesia and Pain Medicine, Vol. 44, No. 3, 2019, p. 333-340.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block
AU - Andersen, Jakob Hessel
AU - Jaeger, Pia
AU - Grevstad, Ulrik
AU - Estrup, Stine
AU - Geisler, Anja
AU - Vilhelmsen, Frederik
AU - Dahl, Jorgen B
AU - Laier, Gunnar Hellmund
AU - Ilfeld, Brian M
AU - Mathiesen, Ole
N1 - © American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019
Y1 - 2019
N2 - BACKGROUND: We tested the joint hypotheses that both perineural and systemic dexmedetomidine prolong the duration of an ulnar nerve block (UNB) compared with ropivacaine alone and that systemic dexmedetomidine is noninferior compared with perineural dexmedetomidine in block prolongation.METHODS: We performed bilateral UNBs in 22 healthy volunteers on two separate days. On the first day, each arm was randomized to either 4 mL ropivacaine 5 mg/mL+1 mL dexmedetomidine 100 µg/mL (Perineural) or 4 mL ropivacaine 5 mg/mL+1 mL saline (Systemic). On the subsequent treatment day, each arm was randomized to 1 mL of saline plus 4 mL of ropivacaine at either 7.5 mg/mL(HiRopi) or 5 mg/mL (NoDex). The primary outcome measure was the duration of sensory block assessed by mechanical discrimination.RESULTS: Mean sensory block duration was longer in both the Perineural (14.4 hours, 95% CI 13.1 to 15.6) and Systemic treatments (9.2 hours, 95% CI 8.6 to 9.8) compared with the NoDex treatment (7.1 hours, 95% CI 6.6 to 7.6) (p<0.0001 for both). Systemic dexmedetomidine was inferior (not noninferior) compared with perineural dexmedetomidine, as the 95% CI of the difference (mean difference 5.2 hour, 95% CI 4.2 to 6.1) exceeded the noninferiority limit of 3.6 hour. Onset time did not differ among the groups. The other test modalities demonstrated similar block durations as the primary outcome.CONCLUSIONS: Adding dexmedetomidine perineurally to ropivacaine doubles the duration of an UNB. Systemic dexmedetomidine also prolongs the duration of UNB, but has less of an effect compared with the perineural route.TRIAL REGISTRATION NUMBER: NCT03222323.
AB - BACKGROUND: We tested the joint hypotheses that both perineural and systemic dexmedetomidine prolong the duration of an ulnar nerve block (UNB) compared with ropivacaine alone and that systemic dexmedetomidine is noninferior compared with perineural dexmedetomidine in block prolongation.METHODS: We performed bilateral UNBs in 22 healthy volunteers on two separate days. On the first day, each arm was randomized to either 4 mL ropivacaine 5 mg/mL+1 mL dexmedetomidine 100 µg/mL (Perineural) or 4 mL ropivacaine 5 mg/mL+1 mL saline (Systemic). On the subsequent treatment day, each arm was randomized to 1 mL of saline plus 4 mL of ropivacaine at either 7.5 mg/mL(HiRopi) or 5 mg/mL (NoDex). The primary outcome measure was the duration of sensory block assessed by mechanical discrimination.RESULTS: Mean sensory block duration was longer in both the Perineural (14.4 hours, 95% CI 13.1 to 15.6) and Systemic treatments (9.2 hours, 95% CI 8.6 to 9.8) compared with the NoDex treatment (7.1 hours, 95% CI 6.6 to 7.6) (p<0.0001 for both). Systemic dexmedetomidine was inferior (not noninferior) compared with perineural dexmedetomidine, as the 95% CI of the difference (mean difference 5.2 hour, 95% CI 4.2 to 6.1) exceeded the noninferiority limit of 3.6 hour. Onset time did not differ among the groups. The other test modalities demonstrated similar block durations as the primary outcome.CONCLUSIONS: Adding dexmedetomidine perineurally to ropivacaine doubles the duration of an UNB. Systemic dexmedetomidine also prolongs the duration of UNB, but has less of an effect compared with the perineural route.TRIAL REGISTRATION NUMBER: NCT03222323.
U2 - 10.1136/rapm-2018-100089
DO - 10.1136/rapm-2018-100089
M3 - Journal article
C2 - 30679332
VL - 44
SP - 333
EP - 340
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
SN - 1098-7339
IS - 3
ER -
ID: 224600553