Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial.

BACKGROUND: Sufentanil combined with ropivacaine is commonly used for epidural labor analgesia, but it may cause some adverse effects. Dexmedetomidine is suitable for long-term and short-term intraoperative sedation and analgesia, and it can reduce the use of the opioid sufentanil. This study compared the efficacy and safety of dexmedetomidine and sufentanil combined with ropivacaine for epidural labor analgesia. METHODS: A randomized, triple-blinded, controlled trial was performed for epidural labor analgesia. All included parturient women were randomized 1:1 by computer to receive ropivacaine combined with dexmedetomidine (group RD) or sufentanil (group RS) from October 2020 to February 2021. The primary outcomes were the pain relief of parturient women assessed by the visual analog scale (VAS) score, and the physical status of newborns assessed by the neonatal behavioral neurological assessment (NBNA) score and Apgar score. Secondary outcomes included the duration of labor stages and adverse reactions of parturient women and newborns. RESULTS: A total of 160 parturient women were included in this study, with 80 in each group. The VAS scores were lower in both groups after the injection of analgesics (in 120 min; RD: 2.6±1.0 vs. RS: 2.5±0.8; P=0.489), and there was no significant difference. The newborns' NBNA (RD: 39.9±0.4 vs. RS: 39.8±0.5; P=0.368) and Apgar scores (RD: 9.8±0.7 vs. RS: 9.7±0.8; P=0.424) were higher than normal standard (NBNA >37; Apgar >7) in both groups, and there were also no significant differences. No differences in parturient women's demographic characteristics, vital signs, Ramsay Sedation Scale (RSS) values, blood loss, duration of labor stages (first and second stages), onset time of analgesia, and dose of analgesics were found between the 2 groups (all P>0.05). The incidence of adverse reactions in parturient women and newborns was low in both groups. CONCLUSIONS: Dexmedetomidine or sufentanil combined with ropivacaine for epidural labor analgesia had similar analgesic effects in clinical practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000038702.

Effects of dexmedetomidine on the function of distal organs and oxidative stress after lower limb ischaemia-reperfusion in elderly patients undergoing unilateral knee arthroplasty.

AIMS: This study aims to evaluate the effects of dexmedetomidine on organ function, inflammation response, and oxidative stress in elderly patients following iatrogenic lower limb ischaemia-reperfusion (IR) during unilateral total knee arthroplasty. METHODS: Following unilateral total knee arthroplasty, 54 elderly patients were randomized to receive either intraoperative intravenous injection of dexmedetomidine (n = 27) or equivalent volume of 0.9% saline (n = 27). Blood samples were harvested at 5 minutes before lower limb tourniquet release (baseline); and 1, 6 and 24 hours after tourniquet release. Surrogate markers of cardiac, pulmonary, hepatic and renal function, oxidative stress, inflammatory response, along with parasympathetic and sympathetic activity were recorded and analysed. RESULTS: The levels of blood xanthine oxidase, creatine kinase, lactic acid and respiratory index increased in patients following tourniquet-induced lower limb IR injury. Dexmedetomidine administration decreased the respiratory index (P = .014, P = .01, and P = .043) and the norepinephrine level (P < .001) at 1, 6 and 24 hours; and decreased the xanthine oxidase level (P = .049, P < .001) at 6 and 24 hours after tourniquet release compared with the Control group. Other measurements, including creatine kinase isoenzyme, lactate dehydrogenase, creatinine, urea nitrogen, glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, malondialdehyde, interleukin-1, interleukin-6 and tumour necrosis factor-α, were not statistically significantly different between the 2 groups. CONCLUSIONS: Intraoperative dexmedetomidine administration in elderly patients dampens the deterioration in respiratory function and suppresses the oxidative stress response in elderly patients following iatrogenic lower limb IR injury.