Efficacy of perineural versus intravenous dexmedetomidine as a peripheral nerve block adjunct: a systematic review.

BACKGROUND: Dexmedetomidine is an effective local anesthetic adjunct for peripheral nerve blocks. The intravenous route for administering dexmedetomidine has been suggested to be equally effective to the perineural route; but comparative evidence is conflicting. OBJECTIVES: This evidence-based review evaluated trials comparing the effects of intravenous to perineural dexmedetomidine on peripheral nerve block characteristics in adult surgical patients. Our primary aim was to evaluate the durations of sensory and motor blockade. Duration of analgesia, onset times of sensory and motor blockade, analgesic consumption, rest pain, and dexmedetomidine-related adverse events were evaluated as secondary outcomes. EVIDENCE REVIEW: We sought randomized trials comparing the effects of intravenous to perineural dexmedetomidine on peripheral nerve block characteristics. The Cochrane Risk of Bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation criteria was used to evaluate the quality of evidence for when an outcome was reported by at least three studies. RESULTS: Ten studies compared intravenous and perineural dexmedetomidine in the setting of upper extremity blocks (seven), lower extremity blocks (two), and truncal block (one). The doses of dexmedetomidine supplementing long-acting local anesthetics varied between a predetermined dose (50 µg) and a weight-based dose (0.5 µg/kg-1.0 µg/kg). Clinical diversity precluded quantitative pooling; and evidence is presented as a systematic review. Compared with the intravenous route, moderate quality evidence found that perineural dexmedetomidine prolonged the duration of sensory blockade in four of six trials and motor blockade in five of seven trials. Perineural dexmedetomidine also hastened the onset of sensory and motor blockade in three of six trials. No differences were reported for the remaining outcomes; and intravenous dexmedetomidine was not superior for any outcome in any of the trials. CONCLUSIONS: Moderate quality evidence appears to suggest that intravenous dexmedetomidine is an inferior peripheral nerve block adjunct compared with perineural dexmedetomidine. Perineural dexmedetomidine is associated with longer durations and faster onset of sensory and motor blockade.

Evaluation of a short-term medical mission to Syrian refugee camps in Turkey.

BACKGROUND: The escalating political and humanitarian crisis in Syria has left thousands detained, killed or displaced in neighboring countries. Given the permission and co-operation of the Turkish health authorities, a short-term medical mission to the Syrian refugee camps in the Hatay province was arranged. MATERIALS AND METHODS: To assess this mission's impact and potential expansion to serve other more emergently inflicted areas both inside and outside the Syrian borders, an evaluation was conducted via survey questionnaire of participating physicians. RESULTS: While almost all respondents found the experience worthwhile and fulfilling, medical, social and educational challenges as well as possible solutions were outlined. CONCLUSION: The use of several specified principles to further guide efforts towards providing service, education, relief, and awareness would result in greater effect, sustainability and growth of the mission.