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Original Research

Open Access

Effects of dexmedetomidine combined with ropivacaine on the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures

  • Wencai Jiang1
  • Siyang Yi1
  • An Xie1
  • Ou Liao1
  • Feng Ju1
  • Xianjie Zhang1,*,

1Department of Anesthesiology, People’s Hospital of Deyang City, 618000 Deyang, Sichuan, China

DOI: 10.22514/sv.2023.019 Vol.19,Issue 2,March 2023 pp.140-144

Submitted: 15 November 2022 Accepted: 12 December 2022

Published: 08 March 2023

*Corresponding Author(s): Xianjie Zhang E-mail: z_xianjie888@163.com

Abstract

To further explore the effects of dexmedetomidine combined with ropivacaine in the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures. 98 patients with lower limb fractures enrolled from January 2020 to January 2022 were randomly divided into the study and control groups, with 49 cases in each group. The study group received dexmedetomidine combined with ropivacaine for nerve block; while the control group received ropivacaine for nerve block. The anesthesia effect (duration time of onset and duration time of sensory block and motor block), heart rate, blood pressure, pain score, and adverse effects were compared between the study and control groups. Patients in the study group given dexmedetomidine combined with ropivacaine for lumbar plexus sciatic nerve block had a longer duration time of sensory block and motor block than the control group, showing a better anesthetic effect. The levels of mean arterial blood pressure (MAP) and heart rate (HR) in the study group at T1, T2, T3, T4, and T5 were significantly lower than that in the control group. The pain scores of the study group was lower than that of the control group, indicating the effects of dexmedetomidine combined with ropivacaine on reducing pain. Besides, the study group showed an adverse reaction incidence of 4.08%, which was slightly higher than that of the control group, with an index of 2.04%, without statistically significant difference. Dexmedetomidine combined with ropivacaine can enhance the effect of ropivacaine block, improve the heart rate index, and reduce patients’ pain, which is one of the reliable schemes in clinical practice for lumbar plexus sciatic nerve block.


Keywords

Dexmedetomidine; Ropivacaine; Lumbar plexus sciatic nerve block; Lower limb fracture in the elderly


Cite and Share

Wencai Jiang,Siyang Yi,An Xie,Ou Liao,Feng Ju,Xianjie Zhang. Effects of dexmedetomidine combined with ropivacaine on the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures. Signa Vitae. 2023. 19(2);140-144.

References

[1] Cunningham DJ, LaRose MA, Gage MJ. Impact of substance use and abuse on opioid demand in lower extremity fracture surgery. Journal of Orthopaedic Trauma. 2021; 35: e171–e176.

[2] Van Wyngaarden JJ, Noehren B, Matuszewski PE, Archer KR. STarT-lower extremity screening tool at six-weeks predicts pain and physical function 12-months after traumatic lower extremity fracture. Injury. 2021; 52: 2444–2450.

[3] Al Nobani MK, Ayasa MA, Tageldin TA, Alhammoud A, Lance MD. The effect of different doses of intravenous dexmedetomidine on the properties of subarachnoid blockade: a systematic review and meta-analysis. Local and Regional Anesthesia. 2020; 13: 207–215.

[4] Sort R, Brorson S, Gögenur I, Hald LL, Nielsen JK, Salling N, et al. Peripheral nerve block anaesthesia and postoperative pain in acute ankle fracture surgery: the AnAnkle randomised trial. British Journal of Anaesthesia. 2021; 126: 881–888.

[5] Mounet B, Choquet O, Swisser F, Biboulet P, Bernard N, Bringuier S, et al. Impact of multiple nerves blocks anaesthesia on intraoperative hypotension and mortality in hip fracture surgery intermediate-risk elderly patients: a propensity score-matched comparison with spinal and general anaesthesia. Anaesthesia Critical Care & Pain Medicine. 2021; 40: 100924.

[6] Chassery C, Marty P, Rontes O, Chaubard M, Vuillaume C, Basset B, et al. Total knee arthroplasty under quadruple nerve block with ropivacaine 0.32%: effect of addition of intravenous dexmedetomidine to intravenous dexamethasone on analgesic duration. Regional Anesthesia & Pain Medicine. 2021; 46: 104–110.

[7] Ji Q, Wang F, He Q, Li Y, Ma Y. Effect of low-dose dexmedetomidine combined with lumbosacral plexus block guided by ultrasound imaging based on image segmentation algorithm in fracture surgery. Computational Intelligence and Neuroscience. 2022; 2022: 8063874.

[8] Griffioen MA, Glutting J, O’Toole RV, Starkweather AR, Lyon D, Dorsey SG, et al. Transition from acute to chronic pain in lower extremity fracture patients. Nursing Research. 2020; 69: 149–156.

[9] Ko S, Lee J, Nam J. Effectiveness of orthopedic implant removal surgery in patients with no implant-related symptoms after fracture union of isolated lower extremity shaft fractures: patient-centered evaluation. To be published in Archives of Orthopaedic and Trauma Surgery. 2021.[Preprint].

[10] Ao C, Wu P, Shao L, Yu J, Wu W. Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction. World Journal of Clinical Cases. 2022; 10: 4064–4071.

[11] Cameron KL, Peck KY, Davi SM, Owens CBD, Svoboda CSJ, DiStefano LJ, et al. Association between landing error scoring system (LESS) items and the incidence rate of lower extremity stress fracture. Orthopaedic Journal of Sports Medicine. 2022; 10: 232596712211007.

[12] Cai H, Fan X, Feng P, Wang X, Xie Y. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis of 57 randomized clinical trials. BMC Anesthesiology. 2021; 21: 233.

[13] Barends CRM, Driesens MK, Struys MMRF, Visser A, Absalom AR. Intranasal dexmedetomidine in elderly subjects with or without beta blockade: a randomised double-blind single-ascending-dose cohort study. British Journal of Anaesthesia. 2020; 124: 411–419.

[14] Dukan R, Krief E, Nizard R. Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia. Journal of Hand Surgery (European Volume). 2020; 45: 857–863.

[15] Morgan L, McKeever TM, Nightingale J, Deakin DE, Moppett IK. Spinal or general anaesthesia for surgical repair of hip fracture and subsequent risk of mortality and morbidity: a database analysis using propensity score-matching. Anaesthesia. 2020; 75: 1173–1179.

[16] Wang C, Zhang Z, Ma W, Liu R, Li Q, Li Y. Perineural dexmedetomidine reduces the median effective concentration of ropivacaine for adductor canal block. Medical Science Monitor. 2021; 27: e929857.

[17] Acquafredda C, Stabile M, Lacitignola L, Centonze P, Di Bella C, Crovace A, et al. Clinical efficacy of dexmedetomidine combined with lidocaine for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Veterinary Anaesthesia and Analgesia. 2021; 48: 962–971.

[18] Marolf V, Ida KK, Siluk D, Struck-Lewicka W, Markuszewski MJ, Sandersen C. Effects of perineural administration of ropivacaine combined with perineural or intravenous administration of dexmedetomidine for sciatic and saphenous nerve blocks in dogs. American Journal of Veterinary Research. 2021; 82: 449–458.

[19] Xue X, Fan J, Ma X, Liu Y, Han X, Leng Y, et al. Effects of local dexmedetomidine administration on the neurotoxicity of ropivacaine for sciatic nerve block in rats. Molecular Medicine Reports. 2020; 22: 4360–4366.

[20] Zhao E, Bai L, Li S, Li L, Dou Z, Huang Y, et al. Dexmedetomidine alleviates CCI-induced neuropathic pain via inhibiting HMGB1-mediated astrocyte activation and the TLR4/NF-κB signaling pathway in rats. Neurotoxicity Research. 2020; 38: 723–732.

[21] Campoy L, Martin-Flores M, Gleed RD, Taylor LC, Yant JE, Pavlinac R. Block duration is substantially longer with a liposomal suspension of bupivacaine than with 0.5% bupivacaine HCl potentiated with dexmedetomidine following an ultrasound-guided sciatic nerve block in beagles. American Journal of Veterinary Research. 2022; 83: ajvr.22.01.0007.

[22] Marolf V, Selz J, Picavet P, Spadavecchia C, Tutunaru A, Sandersen C. Effects of perineural dexmedetomidine combined with ropivacaine on postoperative methadone requirements in dogs after tibial plateau levelling osteotomy: a two-centre study. Veterinary Anaesthesia and Analgesia. 2022; 49: 313–322.

[23] Chen Y, Liu P, Shen D, Liu H, Xu L, Wang J, et al. FAM172A inhibits EMT in pancreatic cancer via ERK-MAPK signaling. Biology Open. 2020; 9: bio048462.

[24] Tian L, Tang G, Liu Q, Yin Y, Li Y, Zhong Y. Blockade of adenosine A1 receptor in nucleus tractus solitarius attenuates baroreflex sensitivity response to dexmedetomidine in rats. Brain Research. 2020; 1743: 146949.

[25] Du D, Qiao Q, Guan Z, Gao Y, Wang Q. Combined sevoflurane-dexmedetomidine and nerve blockade on post-surgical serum oxidative stress biomarker levels in thyroid cancer patients. World Journal of Clinical Cases. 2022; 10: 3027–3034.

[26] Xiao R, Liu LF, Luo YR, Liu C, Jin XB, Zhou W, et al. Dexmedetomidine combined with femoral nerve block provides effective analgesia similar to femoral nerve combined with sciatic nerve block in patients undergoing total knee arthroplasty: a randomized controlled study. Drug Design, Development and Therapy. 2022; 16: 155–164.

[27] Song Y, Liu Y, Yuan Y, Jia X, Zhang W, Wang G, et al. Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: a prospective cohort clinical trial. EBioMedicine. 2021; 70: 103490.

[28] Lehto PM, Vakkala MA, Alahuhta S, Liisanantti JH, Kortekangas THJ, Hiltunen K, et al. Difference in postoperative opioid consumption after spinal versus general anaesthesia for ankle fracture surgery—a retrospective cohort study. Acta Anaesthesiologica Scandinavica. 2021; 65: 1109–1115.

[29] Xu X, Chen X, Zhu W, Zhao J, Liu Y, Duan C, et al. Efficacy and safety of ultrasound guided-deep serratus anterior plane blockade with different doses of dexmedetomidine for women undergoing modified radical mastectomy: a randomized controlled trial. Frontiers in Medicine. 2022; 9: 819239.

[30] Yuan Y, Song Y, Wang G, Jia Y, Zhou Y, Mi X, et al. Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial. BMJ Open. 2021; 11: e043720.

[31] Geoghegan L, Horwitz MD, Dukan R. Re: Dukan R, Krief E, Nizard R. Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia. J Hand Surg Eur. 2020, 45: 857–63. Journal of Hand Surgery (European Volume). 2021; 46: 438–439.

[32] Sindel A, Özalp Ö, Bilgin B. Extraoral approach to a bilateral unfavourable mandibular fracture under local anaesthesia: a case report. Gerodontology. 2021; 38: 228–231.

[33] Uzoigwe CE, Riaz R, Campbell-Jones F. Institutional use of spinal anaesthesia and hip fracture outcomes: analysis of the UK national hip fracture database. British Journal of Anaesthesia. 2022; 128: e349–e350.


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