The Effect of Perineural Administration of Dexmedetomidine on Narcotic Consumption and Pain Intensity in Patients Undergoing Femoral Shaft Fracture Surgery; A Randomized Single-Blind Clinical Trial / 전남의대학술지

Dexmedetomidine is a selective α-2 adrenoceptor agonist with anxiolytic, sedative, and analgesic properties that prolongs analgesia and decreases opioid-related side effects when used in neuraxial and perineural areas as a local anesthetics adjuvant. The current study was designed to evaluate the effects of a single perineural administration of dexmedetomidine without local anesthetics on narcotic consumption and pain intensity in patients with femoral shaft fractures undergoing surgery. This prospective randomized single-blind clinical trial was conducted in patients undergoing femoral fracture shaft surgery. Based on block permuted randomization, the patients were randomly divided into intervention and control groups. The intervention group received 100µg dexmedetomidine, for a femoral nerve block without any local anesthetics. Total intraoperative opioid consumption, postoperative opioid consumption, visual analogue score (VAS) for pain, and hemodynamic parameters were recorded and compared. Finally the data from 60 patients with a mean age of 30.4±12.3 were analyzed (90% male). There were no significant differences between the baseline characteristics of the two groups (p>0.05). The mean total consumption of narcotics was reduced during induction and maintenance of anesthesia in the intervention group (p<0.05). The amount of postoperative narcotics required showed a significant difference in the intervention group compared with the control group (p<0.05). It is likely that perineural administration of dexmedetomidine significantly not only reduced intra and postoperative narcotic requirement but also decreased postoperative pain intensity in patients undergoing femoral shaft surgery. Femoral blockade by dexmedetomidine can provide excellent analgesia while minimizing the side-effects of opioids.

The Effect of Perineural Administration of Dexmedetomidine on Narcotic Consumption and Pain Intensity in Patients Undergoing Femoral Shaft Fracture Surgery; A Randomized Single-Blind Clinical Trial / 전남의대학술지

Dexmedetomidine is a selective α-2 adrenoceptor agonist with anxiolytic, sedative, and analgesic properties that prolongs analgesia and decreases opioid-related side effects when used in neuraxial and perineural areas as a local anesthetics adjuvant. The current study was designed to evaluate the effects of a single perineural administration of dexmedetomidine without local anesthetics on narcotic consumption and pain intensity in patients with femoral shaft fractures undergoing surgery. This prospective randomized single-blind clinical trial was conducted in patients undergoing femoral fracture shaft surgery. Based on block permuted randomization, the patients were randomly divided into intervention and control groups. The intervention group received 100µg dexmedetomidine, for a femoral nerve block without any local anesthetics. Total intraoperative opioid consumption, postoperative opioid consumption, visual analogue score (VAS) for pain, and hemodynamic parameters were recorded and compared. Finally the data from 60 patients with a mean age of 30.4±12.3 were analyzed (90% male). There were no significant differences between the baseline characteristics of the two groups (p>0.05). The mean total consumption of narcotics was reduced during induction and maintenance of anesthesia in the intervention group (p<0.05). The amount of postoperative narcotics required showed a significant difference in the intervention group compared with the control group (p<0.05). It is likely that perineural administration of dexmedetomidine significantly not only reduced intra and postoperative narcotic requirement but also decreased postoperative pain intensity in patients undergoing femoral shaft surgery. Femoral blockade by dexmedetomidine can provide excellent analgesia while minimizing the side-effects of opioids.

Nerve stimulator guided axillary block in painless reduction of distal radius fractures; a randomized clinical trial

Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block [NSAB] with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. In the present randomized clinical trial, 60 patients [18-70 years of age] suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guid-ance and the other procedural sedation and analgesia [PSA] using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale [VAS] and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Sixty patients were randomly divided into two groups [83.3% male]. The mean age of patients was 31 +/- 0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA [p<0.001]. The NSAB group needed a shorter post-operative observation time [P<0.001]. Both groups experienced equal pain relief before, during and after procedure [p>0.05]. It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department

effect of adding magnesium sulfate to lidocaine compared with paracetamol in prevention of acute pain in hand surgery patients under intravenous regional anesthesia [IVRA]

This study was done to compare the analgesic effects of [magnesium plus lidocaine,] [paracetamol plus lidocaine,] and [placebo plus lidocaine] on block characteristics for intravenous regional anesthesia [IVRA] in patients undergoing upper extremity orthopedic surgery. In a double-blind, placebo-controlled randomized clinical trial, 90 patients were selected and entered randomly into three study groups after applying the inclusion and exclusion criteria. Time to start of the sensory and motor block were measured separately and also the duration of these two block types were measured." Post-op pain assessment was measured using a numeric rating scale. Venous samples were checked and compared regarding blood gas and pH measurements. The time from drug injection to sensory block onset was the shortest in the magnesium plus lidocaine group; the time from drug injection to the time of motor block onset was the shortest in the lidocaine plus magnesium group; the duration of the motor block was the longest in the lidocaine plus magnesium group. Addition of magnesium lidocaine in patients undergoing upper extremity orthopedic operations using IVRA decreases significantly the time gap between drug administration and the start of the block; also, this drug combination increases the IVRA block length, while paracetamol does not have such a significant effect

[Comparison of intraoperative hemodynamic parameters and post operative analgesia of gabapentin and tizanidine in patients with tibial fractures]

Preoperative consumption of some drugs can control intra operative and post operative pain. Gabapentin and Tizanidine analgesic effects have been studied but a comparison between analgesic effects of these two drugs has not been studied before. We studied 60 patients with tibial fractures between 15 to 80 years. They were divided into two groups: 30 patients were given 300 mg Gabapentin orally 1 hour before operation [Group G], and 30 patients were given 8 mg Tizanidine by oral route 1 hour before operation [Group T]. Pain was assessed 1 hour before until 12 hours post operation using Visual Analogue Scale [VAS]. All patients had general anesthesia. Vital signs and fentanyl consumption during Surgery, the first time morphine was needed and the total dose of Morphine after operation were assessed. Systolic, diastolic blood pressure and heart rates during operation between two groups were not statistically significant. intra operative fentanyl dose in group G was significantly less than group T[P = 0.001]. The first time morphine was needed in group G was significantly longer than group T [P = 0.001] and total dose of Morphine Consumption during 12 hours after operation in group G was significantly less than group t [P = 0.003]. VAS was only different between two groups 12[th] hours. After operation. Preoperative oral consumption of Gabapentin compared to Tizanidine might facilitate better analgesia and more opioid saving during and after operation