A Randomized Comparison among 0.67 μg/kg, 1 μg/ kg and 1.33 μg/kg of Perineural Dexmedetomidine for Ultrasound-guided Infraclavicular Block:

Samita Pirotesak; Daniah Ghareeb Dhaifallah; Mohamed Alem; Anas Alkhoutani; Alexander Amir; Karoll Rodelo; Juan Francisco Asenjo; Roderick J Finlayson; Julián Aliste; De Q Tran

doi:10.33192/smj.v78i10.283472

Authors

Samita Pirotesak, M.D. Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada; Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Daniah Ghareeb Dhaifallah, M.D. Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada; Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Mohamed Alem, M.D. Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada
Anas Alkhoutani, M.D. Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada
Alexander Amir, M.D., FRCPC Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada
Karoll Rodelo, M.D., FRCPC Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada
Juan Francisco Asenjo, M.D., FRCPC Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada
Roderick J Finlayson, M.D., FRCPC Department of Anesthesia, University of British Columbia, Kelowna, British Columbia, Canada
Julián Aliste, M.D. Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada; Hospital Clinico Universidad de Chile, Department of Anesthesia, University of Chile, Santiago, Chile
De Q Tran, M.D., FRCPC Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada

DOI:

https://doi.org/10.33192/smj.v78i10.283472

Keywords:

dexmedetomidine, brachial plexus block

Abstract

Objective: This randomized trial compared three doses of perineural dexmedetomidine for ultrasound-guided infraclavicular block: 0.67 μg/kg (D1), 1 μg/kg (D2), and 1.33 μg/kg (D3), using an identical admixture of 35 mL of lidocaine 1%- bupivacaine 0.25%- epinephrine 5 μg/mL- perineural dexamethasone (2 mg). We hypothesized a stepwise 15% increase in motor block duration from D1 to D2 to D3.

Materials and Methods: Sixty-nine subjects were randomized to three dexmedetomidine doses. The primary outcome was motor block duration. Secondary outcomes included block onset, surgical anesthesia, analgesia and sensory block duration, and dexmedetomidine-related adverse events.

Results: Motor block duration was longer with D2 and D3 than D1 by omnibus ANOVA/post-hoc testing [18.6 (3.8) vs. 15.8 (3.8) hours, P = 0.028; and 18.6 (4.2) vs. 15.8 (3.8) hours, P = 0.027, respectively]. However, Kaplan-Meier log-rank analysis showed no intergroup difference (P = 0.078). No other differences were observed in sensorimotor block or analgesia duration. Onset was shorter with D2 and D3 than D1 (15 [15-20] vs. 20 [20-25] minutes; P = 0.012; and 15 [15-20] vs. 20 [20-25] minutes; P = 0.007, respectively), with no difference between D2 and D3. Surgical anesthesia and adverse event rates were similar.

Conclusion: With this ICB regimen, 1 and 1.33 μg/kg dexmedetomidine may statistically prolong motor block and shorten onset compared with 0.67 μg/kg. Given inconsistent statistical findings and the secondary outcome of onset, these results are exploratory. Further studies should examine perineural dexmedetomidine for other local anesthetic molecules, injectates, and doses greater than 1.33 μg/kg.

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