Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study | Revista Española de Anestesiología y Reanimación (English Edition)

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Data shown as mean (SD)." ] ] ] "textoCompleto" => "IntroductionSupraclavicular brachial plexus block (SCB) is as regional anaesthesia technique widely used in various types of upper limb surgery. It is cost-effective and associated with good outcomes, patient safety and postoperative analgesia. The supraclavicular approach to the brachial plexus gives the most effective block for upper extremity surgery.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> The blockade is performed in the middle of the brachial plexus, where it is most compact,<a class="elsevierStyleCrossRef" href="#bib0160">2</a> thus ensuring even distribution of the anaesthetic, and rapid onset of complete anesthesia.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> Ropivacaine is an aminoamide local anaesthetic, formulated as an S-enantiomer. It is less cardiotoxic, less arrythmogenic and less toxic to CNS than bupivacaine, and also has intrinsic vasoconstrictor properties.<a class="elsevierStyleCrossRef" href="#bib0170">4</a>Several adjuvants, both opioids and non-opioids, have been studied for brachial plexus block. Dexmedetomidine, a selective α2 adrenergic agonist, has been used as an adjuvant during regional and local anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0175">5–7</a> Animal and human studies have shown that adding dexmedetomidine to local anaesthetics in various regional anaesthesia techniques, such as subarachnoid, epidural, and caudal injections, is both safe and effective. Other studies, however, have reported reduced or negative analgesic effects with dexmedetomidine.<a class="elsevierStyleCrossRefs" href="#bib0190">8–12</a> Nevertheless, much has still to be learned about the analgesic efficacy and clinical utility of adding dexmedetomidine to local anaesthetics during peripheral nerve and nerve plexus block in humans.<a class="elsevierStyleCrossRefs" href="#bib0215">13,14</a> This study was designed to investigate the efficacy of dexmedetomidine as an adjuvant to ropivacaine solutions during SCB for upper extremity surgery, on the hypothesis that dexmedetomidine may improve overall efficacy of this anaesthesia technique.Materials and methodsThis is a prospective, randomized, double-blinded study in 80 ASA Grade I and II patients was conducted from 2011 to 2012. The study was approved by the Institutional Ethics Committee, and written informed consent was obtained from all study subjects. Patients of both sexes, aged between 18 and 60 years, undergoing different types of upper limb orthopaedic surgery under supraclavicular brachial plexus block were included and randomized to two groups of 40 subjects each using a computer programme. The following groups were formed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Group R: ropivacaine 0.50% (30 cc)+placebo.</li><li class="elsevierStyleListItem" id="lsti0010">•Group RD: ropivacaine 0.50% (30 cc)+dexmedetomidine 1μg/kg.</li></ul>Randomization was performed by an independent statistician, and both patients and investigators were blinded to randomization until completion of statistical analysis. Exclusion criteria were: patient refusal, patients with chronic pain (pain lasting more than 12 weeks), patients using chronic analgesic medication (opiods, NSAIDS, anticonvulsants, antidepressants), patients with clotting disorders, a history of brachial plexus injury, allergy to the study drugs, patients taking other α adrenergic blockers, patients with hepatic or renal insufficiency, systemic infection or infection at the injection site, and shoulder surgery. Prior to surgery, patients were instructed in the use of the verbal rating scale (VRS) for pain assessment (VRS: 0=no pain, 10=worst pain possible).On arrival in the operating room, baseline heart rate, blood pressure and oxygen saturation were recorded. An intravenous line was placed in the unaffected limb and infusion of Ringer's lactate was started. Patients were premedicated with 0.03mg/kg i.v. midazolam 10–15min before the start of the nerve block technique. Subcutaneous injection of 2mL of 2% lidocaine was administered at the needle insertion site.All the patients received supraclavicular brachial plexus block administered by an experienced anaesthesiologist (ML). Two different anaesthesiologists (MS and SM), blinded to study groups, assessed the patient intra- and post-operatively. Neural localization was achieved using a nerve locator (Stimuplex® Dig RC, B. Braun Melsungen AG, Melsungen, Germany) connected to a 22G, 50mm stimulating needle (Stimuplex®, Braun, Germany). The location end point was a distal motor response at less than 0.5mA in the median nerve region. Following negative aspiration, 30mL of local anaesthetic solution combined with either placebo or dexmedetomidine, as described above, was infused. A 5-min compression was performed to facilitate even distribution of the anaesthetic. Dexmedetomidine was taken from an unlabeled bottle.Sensory blockade was evaluated every 3min, and motor block every 5min over the first 30min following completion of drug administration. Sensory block was confirmed by pinprick sensation using a 23G needle in all dermatomes of the brachial plexus (C5-T1) including median nerve, radial nerve, ulnar nerve and musculocutaneous nerve. Onset of sensory block was defined as a dull sensation to pin prick along any of these nerves (Grade 1). Complete sensory block was defined as complete loss of sensation to pin prick.Sensory block was evaluated as:<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Motor block was evaluated by the ability to flex the elbow and hand against gravity, as follows<a class="elsevierStyleCrossRef" href="#bib0225">15</a>:<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Onset of motor block was defined as the time from injection of local anaesthetic solution to grade 3 loss of motor function.Blockade was defined as incomplete when analgesia was ineffective in one of the segments supplied by the median, radial, ulnar and musculocutaneous nerve, even 30min after anaesthesia administration. These patients received supplementary i.v. fentanyl (2μg/kg) and midazolam. Blockade failure occurred when more than one nerve was unaffected. In this case, intraoperative general anaesthesia was administered. Haemodynamic variables such as heart rate, blood pressure and oxygen saturation were monitored intraoperatively every 30min after blockade and every 60min post-operatively.Patients rated duration of analgesia subjectively on a VRS of 0–10. VRS scores were noted at 1, 2, 4 and 6h post-operatively. Duration of analgesia (time from completion of local anaesthetic administration to first need for i.m. ketorolac as rescue analgesia) was noted. All patients were monitored intra- and post-operatively for side effects, such as nausea, vomiting, dryness of mouth or somnolence, and complications such as pneumothorax, haematoma, local anaesthetic toxicity and post-block neuropathy. The duration of sensory block was defined as the time from completion of local anaesthetic administration to complete regression of block in all nerves. The duration of motor block was defined as the time from completion of local anaesthetic administration to full recovery of motor function of the hand and forearm.Primary outcome measure was duration of analgesia. Secondary measures were onset and duration of sensory blockade, pain scores, onset and duration of motor blockade, and evidence of any adverse drug reactions.Sample size was estimated using first rescue analgesic requirement between two groups as the primary outcome. Mean duration in each group was 120min. The probability of detecting a difference of 10% (12min), at the p<0.05 level, is 80% (1−beta=0.80). On the basis of a previous study assuming an inter-group standard deviation of 18min, we needed to study at least 38 patients per group to be able to reject the null hypothesis that the means of the study population are equal, with a power of 0.80. Raw data were entered into a Microsoft Excel spreadsheet and analysed using standard statistical software SPSS® version 19.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were analysed using the Fisher's exact test. Normally distributed continuous variables were analysed using the t test, and significance was set at p<0.05.ResultsDemographic variables, duration of surgery, and intravenous sedation for block placement (p>0.05) were comparable in both groups, and are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Baseline haemodynamic parameters were comparable in both groups. No significant differences were observed in intraoperative pulse rate or mean arterial pressure between groups (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>, <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the RD (dexmedetomidine) group vs. R group (controls), time to onset of sensory blockade was shorter (10.75±2.71 vs. 16.75±2.96min, p=0.003), sensory block duration was longer (379.40±55.09 vs. 211.60±47.88min, p=0.002), time to onset of motor blockade was shorter (14.35±2.58 vs. 20.25±4.13min, p=0.003), motor block duration was longer (312.0±49.91 vs. 184.7±36.76min, p=0.002), duration of postoperative analgesia was longer (413.73±89.92 vs. 197.35±28.67min, p=0.002) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>) and pain scores were lower. All these differences were statistically significant. (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Five patients in group R and three patients in group RD required supplementary i.v. fentanyl (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>). Six patients in the dexmedetomidine group presented somnolence vs. none in the control group (Group R) (p=0.04) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionDexmedetomidine is a selective α2-adrenergic receptor (AR) agonist with evidence of a high ratio of α2–α1 activity (1620:1) compared to clonidine (220:1).<a class="elsevierStyleCrossRef" href="#bib0230">16</a> The mechanism by which α-AR agonists produce analgesia and sedation is not fully understood, but is likely to be multi-factorial. Although dexmedetomidine has analgesic properties and many other advantages, it does not cause respiratory depression,<a class="elsevierStyleCrossRefs" href="#bib0235">17,18</a> making it a potentially useful and safe adjuvant in many clinical procedures. Both the hypnotic and supraspinal analgesic effects of dexmedetomidine are mediated by noradrenergic neurons (via hyperpolarization). The mechanism of action is as follows: (1) it inhibits norepinephrine release and its associated activity in the descending noradrenergic pathway (secondary to activation of central α2s); and (2) it suppresses neuronal firing in the locus coeruleus.<a class="elsevierStyleCrossRefs" href="#bib0245">19,20</a> Suppression of these inhibitory controls leads to the release of mediators and neurotransmitters that reduce histamine secretion and produce hypnosis (similar to normal sleep), with no evidence of respiratory depression.<a class="elsevierStyleCrossRef" href="#bib0255">21</a> In addition, suppression of activity of the descending noradrenergic pathway (which modulates nociceptive neurotransmission) prevents propagation of pain signals, resulting in analgesia or decreased awareness of noxious stimuli.In our study, onset of sensory block was significantly shorter in the RD group compared to the R group (10.75 vs. 16.75min). Similar results were reported by Ammar and Mahmoud,<a class="elsevierStyleCrossRef" href="#bib0260">22</a> who found that onset of sensory block was significantly faster in bupivacaine combined with dexmedetomidine, compared to bupivacaine alone (13.2±2.1 vs. 19.4±2.8min) in ultrasound guided infraclavicular brachial plexus block. According to Swami et al.,<a class="elsevierStyleCrossRef" href="#bib0265">23</a> time to sensory onset after supraclavicular brachial plexus block was 1.77±1.28min in the bupivacaine-dexmedetomidine group vs. 2.33±1.21min in the bupivacaine-clonidine group. We found no studies combining dexmedetomidine with ropivacaine in brachial plexus block.In our study, sensory block duration was also significantly longer in the RD group compared to the R group. Esmaoglu et al.,<a class="elsevierStyleCrossRef" href="#bib0270">24</a> reported similar results in axillary brachial block combining dexmedetomidine with levobupivacaine. In their study, the duration of sensory block in the levobupivacaine-dexmedetomidine group was 887±66.23min, compared to 673±73.77min in the levobupivacaine group. Ammar and Mahmoud<a class="elsevierStyleCrossRef" href="#bib0260">22</a> and Swami et al.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> reported similar results in their studies.In this study, we found that onset of motor blockade was shorter and duration longer in the RD group. These findings echo those of Ammar and Mahmoud,<a class="elsevierStyleCrossRef" href="#bib0260">22</a> Swami et al.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> and Esmaoglu et al.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> in terms of motor blockade. Kaygusuz et al.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> found prolonged duration of motor blockade in the levobupivacaine-dexmedetomidine group vs. the levobupivacaine group, but found no significant difference in onset of motor blockade.We found a significant improvement in post-operative analgesia in the RD group vs. the R group. Memis et al.<a class="elsevierStyleCrossRef" href="#bib0280">26</a> also found that adding dexmedetomidine to lidocaine for intravenous regional anaesthesia prolonged duration of post-operative analgesia, with no side effects. This increased duration of post-operative analgesia could be due to various mechanisms of nerve conduction block such as hyperpolarisation,<a class="elsevierStyleCrossRef" href="#bib0285">27</a> decreased compound action potential,<a class="elsevierStyleCrossRef" href="#bib0290">28</a> and inhibition of voltage gated sodium channels.<a class="elsevierStyleCrossRef" href="#bib0295">29</a>Three out of 30 patients in the RD group presented somnolence vs. none in the R group, a finding that was statistically significant. Ammar and Mahmoud also reported a greater incidence of somnolence in patients in the RD group. Demiraran et al.,<a class="elsevierStyleCrossRef" href="#bib0300">30</a> found sedation to be greater with dexmedetomidine compared to midazolam. However, we did not find the degree of sedation to be clinically significant.ConclusionDexmedetomidine added to ropivacaine for supraclavicular brachial plexus block reduces onset time and prolongs duration of both motor and sensory block and post-operative analgesia compared to ropivacaine alone, with little alteration in haemodynamic parameters. This shows that dexmedetomidine can be safely used as an adjuvant to ropivacaine for supraclavicular brachial plexus block.Conflict of interestThe authors declare they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres611604" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec625575" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres611603" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec625574" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-26" "fechaAceptado" => "2015-04-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec625575" "palabras" => array:3 [ 0 => "Dexmedetomidine" 1 => "Ropivacaine" 2 => "Supraclavicular brachial plexus block" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec625574" "palabras" => array:3 [ 0 => "Dexmedetomidina" 1 => "Ropivacaína" 2 => "Bloqueo supraclavicular del plexo braquial" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundDexmedetomidine is a new α2 receptor agonist with analgesic and sedative properties. We used dexmedetomidine along with ropivacaine for supraclavicular brachial plexus block. MethodsEighty ASA grade I–II patients, 18–60 years old, scheduled for elective upper limb orthopaedic surgery under supraclavicular brachial plexus block, were included in this prospective study. The patients were randomly assigned to group R (ropivacaine alone) and group RD (ropivacaine and dexmedetomidine) (40 patients in each group). Group R received ropivacaine 0.50% (30 cc)+placebo and group RD received ropivacaine 0.50% (30 cc)+dexmedetomidine 1μg/kg. Primary outcome measure was duration of analgesia. Secondary measures were onset and duration of sensory blockade, pain scores, onset and duration of motor blockade, and evidence of any adverse drug reactions. ResultsThere was no significant difference haemodynamic parameter during intra-operative period. Group RD showed a statistically significant shorter time to onset of sensory blockade (10.75±2.71 vs. 16.75±2.96min, p=0.003), longer sensory block duration (379.40±55.09 vs. 211.60±47.88min, p=0.002), shorter onset time to motor blockade (14.35±2.58 vs. 20.25±4.13min, p=0.003), longer motor block duration (312.0±49.91 vs. 184.7±36.76min, p=0.002), longer duration of postoperative analgesia (413.73±89.92 vs. 197.35±28.67min, p=0.002). Three patients in the group RD developed somnolence (p=0.04). ConclusionDexmedetomidine along with ropivacaine decreases the onset of motor and sensory block and increases the duration of sensory and motor block in supraclavicular brachial plexus block." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa dexmedetomidina es un nuevo agonista de los receptores α2 con propiedades analgésicas y sedantes. Utilizamos dexmedetomidina junto con ropivacaína para realizar un bloqueo supraclavicular del plexo braquial. MétodosEn esta investigación se incluyeron 80 pacientes ASA I-II, de 18–60 años, programados para cirugía ortopédica de extremidad superior con bloqueo supraclavicular del plexo braquial. A los pacientes (40 en cada grupo) se les asignó aleatoriamente el grupo R (solo ropivacaína) y el grupo RD (ropivacaína y dexmedetomidina). El grupo R recibió ropivacaína 0,50% (30cc)+placebo y el grupo RD ropivacaína 0,50% (30cc) y dexmedetomidina 1μg/kg. El criterio de valoración primario fue la duración de la analgesia, mientras que los secundarios fueron el inicio y la duración del bloqueo sensitivo, las puntuaciones de dolor, el inicio y la duración del bloqueo motor y la reacción adversa a los fármacos. ResultadosNo hubo diferencias significativas en los parámetros hemodinámicos durante el período intraoperatorio. El grupo RD presentó un tiempo significativamente más corto desde el punto de vista estadístico para el inicio del bloqueo sensitivo (10,75±2,71 frente a 16,75±2,96min; p=0,003), una duración más prolongada del bloqueo sensitivo (379,40±55,09 frente a 211,60±47,88min; p=0,002), un menor tiempo para el inicio del bloqueo motor (14,35±2,58 frente a 20,25±4,13min; p=0,003), una duración más prolongada del bloqueo motor (312±49,91 frente a 184,7±36,76min; p=0,002), y una duración más prolongada de la analgesia postoperatoria (413,73±89,92 frente 197,35±28,67min; p=0,002). Tres pacientes del grupo RD presentaron somnolencia (p=0,04). ConclusiónLa dexmedetomidina combinada con la ropivacaína reduce el inicio del bloqueo sensitivo y motor, y aumenta la duración del bloqueo sensitivo y motor en el bloqueo supraclavicular del plexo braquial." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Das B, Lakshmegowda M, Sharma M, Mitra S, Chauhan R. Bloqueo supraclavicular del plexo braquial con ropivacaína sola o en combinación con dexmedetomidina en cirugías de extremidades superiores: ensayo comparativo, prospectivo, monitorización y con doble enmascaramiento. Rev Esp Anestesiol Reanim. 2016;63:135–140." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 961 "Ancho" => 1613 "Tamanyo" => 94230 ] ] "descripcion" => array:1 [ "en" => "Heart rate in both groups. Data shown as mean (SD)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 991 "Ancho" => 1610 "Tamanyo" => 97816 ] ] "descripcion" => array:1 [ "en" => "Mean arterial pressure in both groups. Data shown as mean (SD)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 867 "Ancho" => 1649 "Tamanyo" => 61712 ] ] "descripcion" => array:1 [ "en" => "Verbal rating scale (VRS) scores in both groups. Data shown as mean (SD)." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data expressed as mean (SD)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R Group (n=40) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RD Group (n=40) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.2 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.52 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex (M/F) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.33 (7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.85 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of surgery (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 (9.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">I.v. Midazolam (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9 (0.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 (0.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1001880.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic data and surgical parameters." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Data expressed as mean (SD) and numbers (%)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RD Group (n=40) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R Group (n=40) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% confidence interval \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Onset of sensory block (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.75 (2.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.75 (2.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58–0.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of sensory block (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">379.40 (55.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">211.60 (47.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.65–1.96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Onset of motor block (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.35 (2.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.25 (4.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65–0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of motor block (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">312.0 (49.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">184.7 (36.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.56–1.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Durantion of analgesia (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">413.73 (89.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">197.35 (28.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.93–2.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. of patients requiring i.v. fentanyl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. of patients requiring i.v. ketorolac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (87.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Postoperative somnolence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1001881.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Statistically significant." ] ] ] "descripcion" => array:1 [ "en" => "Ropivacaine (R Group) + Placebo and Ropivacaine + dexmedetomidine (RD Group). Data expressed as mean (SD) and numbers (%)." ] ] 5 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sharp sensation to pin prick \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Analgesia, dull sensation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaesthesia, loss of sensation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1001878.png" ] ] ] ] ] 6 => array:5 [ "identificador" => "tbl0010" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ability to flex and extend the forearm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ability to flex and extend only the wrist and fingers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ability to flex and extend only the fingers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inability to move the forearm, wrist, and fingers \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1001879.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of dexmedetomidine along with bupivacaine for brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. 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Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study

Bloqueo supraclavicular del plexo braquial con ropivacaína sola o en combinación con dexmedetomidina en cirugías de extremidades superiores: ensayo comparativo, prospectivo, monitorización y con doble enmascaramiento

B. Dasa,

Corresponding author

bikramjit.anesth@gmail.com

Corresponding author.

, M. Lakshmegowdab, M. Sharmab, S. Mitraa, R. Chauhana

a Departamento de Anestesiología y Cuidados Críticos, Government Medical College, Haldwani, Uttarakhand, India

b J N Medical College, AMU Aligarh, Uttar Pradesh, India

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        "titulo" => "Bloqueo supraclavicular del plexo braquial con ropivaca&#237;na sola o en combinaci&#243;n con dexmedetomidina en cirug&#237;as de extremidades superiores&#58; ensayo comparativo&#44; prospectivo&#44; monitorizaci&#243;n y con doble enmascaramiento"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Mean arterial pressure in both groups&#46; Data shown as mean &#40;SD&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Supraclavicular brachial plexus block &#40;SCB&#41; is as regional anaesthesia technique widely used in various types of upper limb surgery&#46; It is cost-effective and associated with good outcomes&#44; patient safety and postoperative analgesia&#46; The supraclavicular approach to the brachial plexus gives the most effective block for upper extremity surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> The blockade is performed in the middle of the brachial plexus&#44; where it is most compact&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> thus ensuring even distribution of the anaesthetic&#44; and rapid onset of complete anesthesia&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Ropivacaine is an aminoamide local anaesthetic&#44; formulated as an S-enantiomer&#46; It is less cardiotoxic&#44; less arrythmogenic and less toxic to CNS than bupivacaine&#44; and also has intrinsic vasoconstrictor properties&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several adjuvants&#44; both opioids and non-opioids&#44; have been studied for brachial plexus block&#46; Dexmedetomidine&#44; a selective &#945;2 adrenergic agonist&#44; has been used as an adjuvant during regional and local anesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7</span></a> Animal and human studies have shown that adding dexmedetomidine to local anaesthetics in various regional anaesthesia techniques&#44; such as subarachnoid&#44; epidural&#44; and caudal injections&#44; is both safe and effective&#46; Other studies&#44; however&#44; have reported reduced or negative analgesic effects with dexmedetomidine&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#8211;12</span></a> Nevertheless&#44; much has still to be learned about the analgesic efficacy and clinical utility of adding dexmedetomidine to local anaesthetics during peripheral nerve and nerve plexus block in humans&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a> This study was designed to investigate the efficacy of dexmedetomidine as an adjuvant to ropivacaine solutions during SCB for upper extremity surgery&#44; on the hypothesis that dexmedetomidine may improve overall efficacy of this anaesthesia technique&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This is a prospective&#44; randomized&#44; double-blinded study in 80 ASA Grade I and II patients was conducted from 2011 to 2012&#46; The study was approved by the Institutional Ethics Committee&#44; and written informed consent was obtained from all study subjects&#46; Patients of both sexes&#44; aged between 18 and 60 years&#44; undergoing different types of upper limb orthopaedic surgery under supraclavicular brachial plexus block were included and randomized to two groups of 40 subjects each using a computer programme&#46; The following groups were formed&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Group R&#58; ropivacaine 0&#46;50&#37; &#40;30 cc&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Group RD&#58; ropivacaine 0&#46;50&#37; &#40;30 cc&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>dexmedetomidine 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">Randomization was performed by an independent statistician&#44; and both patients and investigators were blinded to randomization until completion of statistical analysis&#46; Exclusion criteria were&#58; patient refusal&#44; patients with chronic pain &#40;pain lasting more than 12 weeks&#41;&#44; patients using chronic analgesic medication &#40;opiods&#44; NSAIDS&#44; anticonvulsants&#44; antidepressants&#41;&#44; patients with clotting disorders&#44; a history of brachial plexus injury&#44; allergy to the study drugs&#44; patients taking other &#945; adrenergic blockers&#44; patients with hepatic or renal insufficiency&#44; systemic infection or infection at the injection site&#44; and shoulder surgery&#46; Prior to surgery&#44; patients were instructed in the use of the verbal rating scale &#40;VRS&#41; for pain assessment &#40;VRS&#58; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no pain&#44; 10<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>worst pain possible&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">On arrival in the operating room&#44; baseline heart rate&#44; blood pressure and oxygen saturation were recorded&#46; An intravenous line was placed in the unaffected limb and infusion of Ringer&#39;s lactate was started&#46; Patients were premedicated with 0&#46;03<span class="elsevierStyleHsp" style=""></span>mg&#47;kg i&#46;v&#46; midazolam 10&#8211;15<span class="elsevierStyleHsp" style=""></span>min before the start of the nerve block technique&#46; Subcutaneous injection of 2<span class="elsevierStyleHsp" style=""></span>mL of 2&#37; lidocaine was administered at the needle insertion site&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All the patients received supraclavicular brachial plexus block administered by an experienced anaesthesiologist &#40;ML&#41;&#46; Two different anaesthesiologists &#40;MS and SM&#41;&#44; blinded to study groups&#44; assessed the patient intra- and post-operatively&#46; Neural localization was achieved using a nerve locator &#40;Stimuplex<span class="elsevierStyleSup">&#174;</span> Dig RC&#44; B&#46; Braun Melsungen AG&#44; Melsungen&#44; Germany&#41; connected to a 22<span class="elsevierStyleHsp" style=""></span>G&#44; 50<span class="elsevierStyleHsp" style=""></span>mm stimulating needle &#40;Stimuplex<span class="elsevierStyleSup">&#174;</span>&#44; Braun&#44; Germany&#41;&#46; The location end point was a distal motor response at less than 0&#46;5<span class="elsevierStyleHsp" style=""></span>mA in the median nerve region&#46; Following negative aspiration&#44; 30<span class="elsevierStyleHsp" style=""></span>mL of local anaesthetic solution combined with either placebo or dexmedetomidine&#44; as described above&#44; was infused&#46; A 5-min compression was performed to facilitate even distribution of the anaesthetic&#46; Dexmedetomidine was taken from an unlabeled bottle&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sensory blockade was evaluated every 3<span class="elsevierStyleHsp" style=""></span>min&#44; and motor block every 5<span class="elsevierStyleHsp" style=""></span>min over the first 30<span class="elsevierStyleHsp" style=""></span>min following completion of drug administration&#46; Sensory block was confirmed by pinprick sensation using a 23<span class="elsevierStyleHsp" style=""></span>G needle in all dermatomes of the brachial plexus &#40;C5-T1&#41; including median nerve&#44; radial nerve&#44; ulnar nerve and musculocutaneous nerve&#46; Onset of sensory block was defined as a dull sensation to pin prick along any of these nerves &#40;Grade 1&#41;&#46; Complete sensory block was defined as complete loss of sensation to pin prick&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Sensory block was evaluated as&#58;<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p><p id="par0055" class="elsevierStylePara elsevierViewall">Motor block was evaluated by the ability to flex the elbow and hand against gravity&#44; as follows<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#58;<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p><p id="par0060" class="elsevierStylePara elsevierViewall">Onset of motor block was defined as the time from injection of local anaesthetic solution to grade 3 loss of motor function&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Blockade was defined as incomplete when analgesia was ineffective in one of the segments supplied by the median&#44; radial&#44; ulnar and musculocutaneous nerve&#44; even 30<span class="elsevierStyleHsp" style=""></span>min after anaesthesia administration&#46; These patients received supplementary i&#46;v&#46; fentanyl &#40;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#41; and midazolam&#46; Blockade failure occurred when more than one nerve was unaffected&#46; In this case&#44; intraoperative general anaesthesia was administered&#46; Haemodynamic variables such as heart rate&#44; blood pressure and oxygen saturation were monitored intraoperatively every 30<span class="elsevierStyleHsp" style=""></span>min after blockade and every 60<span class="elsevierStyleHsp" style=""></span>min post-operatively&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients rated duration of analgesia subjectively on a VRS of 0&#8211;10&#46; VRS scores were noted at 1&#44; 2&#44; 4 and 6<span class="elsevierStyleHsp" style=""></span>h post-operatively&#46; Duration of analgesia &#40;time from completion of local anaesthetic administration to first need for i&#46;m&#46; ketorolac as rescue analgesia&#41; was noted&#46; All patients were monitored intra- and post-operatively for side effects&#44; such as nausea&#44; vomiting&#44; dryness of mouth or somnolence&#44; and complications such as pneumothorax&#44; haematoma&#44; local anaesthetic toxicity and post-block neuropathy&#46; The duration of sensory block was defined as the time from completion of local anaesthetic administration to complete regression of block in all nerves&#46; The duration of motor block was defined as the time from completion of local anaesthetic administration to full recovery of motor function of the hand and forearm&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Primary outcome measure was duration of analgesia&#46; Secondary measures were onset and duration of sensory blockade&#44; pain scores&#44; onset and duration of motor blockade&#44; and evidence of any adverse drug reactions&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Sample size was estimated using first rescue analgesic requirement between two groups as the primary outcome&#46; Mean duration in each group was 120<span class="elsevierStyleHsp" style=""></span>min&#46; The probability of detecting a difference of 10&#37; &#40;12<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; at the <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 level&#44; is 80&#37; &#40;1<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>beta<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#41;&#46; On the basis of a previous study assuming an inter-group standard deviation of 18<span class="elsevierStyleHsp" style=""></span>min&#44; we needed to study at least 38 patients per group to be able to reject the null hypothesis that the means of the study population are equal&#44; with a power of 0&#46;80&#46; Raw data were entered into a Microsoft Excel spreadsheet and analysed using standard statistical software SPSS<span class="elsevierStyleSup">&#174;</span> version 19&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Categorical variables were analysed using the Fisher&#39;s exact test&#46; Normally distributed continuous variables were analysed using the <span class="elsevierStyleItalic">t</span> test&#44; and significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Demographic variables&#44; duration of surgery&#44; and intravenous sedation for block placement &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; were comparable in both groups&#44; and are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Baseline haemodynamic parameters were comparable in both groups&#46; No significant differences were observed in intraoperative pulse rate or mean arterial pressure between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#44; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In the RD &#40;dexmedetomidine&#41; group vs&#46; R group &#40;controls&#41;&#44; time to onset of sensory blockade was shorter &#40;10&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;71 vs&#46; 16&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;96<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; sensory block duration was longer &#40;379&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#46;09 vs&#46; 211&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#46;88<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; time to onset of motor blockade was shorter &#40;14&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;58 vs&#46; 20&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;13<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; motor block duration was longer &#40;312&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;91 vs&#46; 184&#46;7<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;76<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; duration of postoperative analgesia was longer &#40;413&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;92 vs&#46; 197&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;67<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41; and pain scores were lower&#46; All these differences were statistically significant&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Five patients in group R and three patients in group RD required supplementary i&#46;v&#46; fentanyl &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41;&#46; Six patients in the dexmedetomidine group presented somnolence vs&#46; none in the control group &#40;Group R&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Dexmedetomidine is a selective &#945;2-adrenergic receptor &#40;AR&#41; agonist with evidence of a high ratio of &#945;2&#8211;&#945;1 activity &#40;1620&#58;1&#41; compared to clonidine &#40;220&#58;1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> The mechanism by which &#945;-AR agonists produce analgesia and sedation is not fully understood&#44; but is likely to be multi-factorial&#46; Although dexmedetomidine has analgesic properties and many other advantages&#44; it does not cause respiratory depression&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> making it a potentially useful and safe adjuvant in many clinical procedures&#46; Both the hypnotic and supraspinal analgesic effects of dexmedetomidine are mediated by noradrenergic neurons &#40;via hyperpolarization&#41;&#46; The mechanism of action is as follows&#58; &#40;1&#41; it inhibits norepinephrine release and its associated activity in the descending noradrenergic pathway &#40;secondary to activation of central &#945;2s&#41;&#59; and &#40;2&#41; it suppresses neuronal firing in the locus coeruleus&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> Suppression of these inhibitory controls leads to the release of mediators and neurotransmitters that reduce histamine secretion and produce hypnosis &#40;similar to normal sleep&#41;&#44; with no evidence of respiratory depression&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> In addition&#44; suppression of activity of the descending noradrenergic pathway &#40;which modulates nociceptive neurotransmission&#41; prevents propagation of pain signals&#44; resulting in analgesia or decreased awareness of noxious stimuli&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our study&#44; onset of sensory block was significantly shorter in the RD group compared to the R group &#40;10&#46;75 vs&#46; 16&#46;75<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Similar results were reported by Ammar and Mahmoud&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> who found that onset of sensory block was significantly faster in bupivacaine combined with dexmedetomidine&#44; compared to bupivacaine alone &#40;13&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1 vs&#46; 19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8<span class="elsevierStyleHsp" style=""></span>min&#41; in ultrasound guided infraclavicular brachial plexus block&#46; According to Swami et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> time to sensory onset after supraclavicular brachial plexus block was 1&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28<span class="elsevierStyleHsp" style=""></span>min in the bupivacaine-dexmedetomidine group vs&#46; 2&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21<span class="elsevierStyleHsp" style=""></span>min in the bupivacaine-clonidine group&#46; We found no studies combining dexmedetomidine with ropivacaine in brachial plexus block&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study&#44; sensory block duration was also significantly longer in the RD group compared to the R group&#46; Esmaoglu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> reported similar results in axillary brachial block combining dexmedetomidine with levobupivacaine&#46; In their study&#44; the duration of sensory block in the levobupivacaine-dexmedetomidine group was 887<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&#46;23<span class="elsevierStyleHsp" style=""></span>min&#44; compared to 673<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#46;77<span class="elsevierStyleHsp" style=""></span>min in the levobupivacaine group&#46; Ammar and Mahmoud<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> and Swami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> reported similar results in their studies&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In this study&#44; we found that onset of motor blockade was shorter and duration longer in the RD group&#46; These findings echo those of Ammar and Mahmoud&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Swami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> and Esmaoglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> in terms of motor blockade&#46; Kaygusuz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> found prolonged duration of motor blockade in the levobupivacaine-dexmedetomidine group vs&#46; the levobupivacaine group&#44; but found no significant difference in onset of motor blockade&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We found a significant improvement in post-operative analgesia in the RD group vs&#46; the R group&#46; Memis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> also found that adding dexmedetomidine to lidocaine for intravenous regional anaesthesia prolonged duration of post-operative analgesia&#44; with no side effects&#46; This increased duration of post-operative analgesia could be due to various mechanisms of nerve conduction block such as hyperpolarisation&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> decreased compound action potential&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> and inhibition of voltage gated sodium channels&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Three out of 30 patients in the RD group presented somnolence vs&#46; none in the R group&#44; a finding that was statistically significant&#46; Ammar and Mahmoud also reported a greater incidence of somnolence in patients in the RD group&#46; Demiraran et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> found sedation to be greater with dexmedetomidine compared to midazolam&#46; However&#44; we did not find the degree of sedation to be clinically significant&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Dexmedetomidine added to ropivacaine for supraclavicular brachial plexus block reduces onset time and prolongs duration of both motor and sensory block and post-operative analgesia compared to ropivacaine alone&#44; with little alteration in haemodynamic parameters&#46; This shows that dexmedetomidine can be safely used as an adjuvant to ropivacaine for supraclavicular brachial plexus block&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest&#46;</p></span></span>"
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          "identificador" => "xres611604"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
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            1 => array:2 [
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        1 => array:2 [
          "identificador" => "xpalclavsec625575"
          "titulo" => "Keywords"
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        2 => array:3 [
          "identificador" => "xres611603"
          "titulo" => "Resumen"
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            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes"
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              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
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              "titulo" => "Resultados"
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              "titulo" => "Conclusi&#243;n"
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          "identificador" => "xpalclavsec625574"
          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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          "titulo" => "Conclusion"
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          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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    "tienePdf" => true
    "fechaRecibido" => "2014-12-26"
    "fechaAceptado" => "2015-04-13"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec625575"
          "palabras" => array:3 [
            0 => "Dexmedetomidine"
            1 => "Ropivacaine"
            2 => "Supraclavicular brachial plexus block"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Dexmedetomidina"
            1 => "Ropivaca&#237;na"
            2 => "Bloqueo supraclavicular del plexo braquial"
          ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dexmedetomidine is a new &#945;2 receptor agonist with analgesic and sedative properties&#46; We used dexmedetomidine along with ropivacaine for supraclavicular brachial plexus block&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eighty ASA grade <span class="elsevierStyleSmallCaps">I&#8211;II</span> patients&#44; 18&#8211;60 years old&#44; scheduled for elective upper limb orthopaedic surgery under supraclavicular brachial plexus block&#44; were included in this prospective study&#46; The patients were randomly assigned to group R &#40;ropivacaine alone&#41; and group RD &#40;ropivacaine and dexmedetomidine&#41; &#40;40 patients in each group&#41;&#46; Group R received ropivacaine 0&#46;50&#37; &#40;30 cc&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo and group RD received ropivacaine 0&#46;50&#37; &#40;30 cc&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>dexmedetomidine 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#46; Primary outcome measure was duration of analgesia&#46; Secondary measures were onset and duration of sensory blockade&#44; pain scores&#44; onset and duration of motor blockade&#44; and evidence of any adverse drug reactions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There was no significant difference haemodynamic parameter during intra-operative period&#46; Group RD showed a statistically significant shorter time to onset of sensory blockade &#40;10&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;71 vs&#46; 16&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;96<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; longer sensory block duration &#40;379&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#46;09 vs&#46; 211&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#46;88<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; shorter onset time to motor blockade &#40;14&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;58 vs&#46; 20&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;13<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; longer motor block duration &#40;312&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;91 vs&#46; 184&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;76<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; longer duration of postoperative analgesia &#40;413&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;92 vs&#46; 197&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;67<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Three patients in the group RD developed somnolence &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dexmedetomidine along with ropivacaine decreases the onset of motor and sensory block and increases the duration of sensory and motor block in supraclavicular brachial plexus block&#46;</p></span>"
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            "titulo" => "Background"
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            "titulo" => "Methods"
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      "es" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La dexmedetomidina es un nuevo agonista de los receptores &#945;2 con propiedades analg&#233;sicas y sedantes&#46; Utilizamos dexmedetomidina junto con ropivaca&#237;na para realizar un bloqueo supraclavicular del plexo braquial&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En esta investigaci&#243;n se incluyeron 80 pacientes ASA I-II&#44; de 18&#8211;60 a&#241;os&#44; programados para cirug&#237;a ortop&#233;dica de extremidad superior con bloqueo supraclavicular del plexo braquial&#46; A los pacientes &#40;40 en cada grupo&#41; se les asign&#243; aleatoriamente el grupo R &#40;solo ropivaca&#237;na&#41; y el grupo RD &#40;ropivaca&#237;na y dexmedetomidina&#41;&#46; El grupo R recibi&#243; ropivaca&#237;na 0&#44;50&#37; &#40;30<span class="elsevierStyleHsp" style=""></span>cc&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>placebo y el grupo RD ropivaca&#237;na 0&#44;50&#37; &#40;30<span class="elsevierStyleHsp" style=""></span>cc&#41; y dexmedetomidina 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#46; El criterio de valoraci&#243;n primario fue la duraci&#243;n de la analgesia&#44; mientras que los secundarios fueron el inicio y la duraci&#243;n del bloqueo sensitivo&#44; las puntuaciones de dolor&#44; el inicio y la duraci&#243;n del bloqueo motor y la reacci&#243;n adversa a los f&#225;rmacos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias significativas en los par&#225;metros hemodin&#225;micos durante el per&#237;odo intraoperatorio&#46; El grupo RD present&#243; un tiempo significativamente m&#225;s corto desde el punto de vista estad&#237;stico para el inicio del bloqueo sensitivo &#40;10&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;71 frente a 16&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;96<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; una duraci&#243;n m&#225;s prolongada del bloqueo sensitivo &#40;379&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#44;09 frente a 211&#44;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;88<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; un menor tiempo para el inicio del bloqueo motor &#40;14&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;58 frente a 20&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;13<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; una duraci&#243;n m&#225;s prolongada del bloqueo motor &#40;312<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#44;91 frente a 184&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#44;76<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; y una duraci&#243;n m&#225;s prolongada de la analgesia postoperatoria &#40;413&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#44;92 frente 197&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;67<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Tres pacientes del grupo RD presentaron somnolencia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La dexmedetomidina combinada con la ropivaca&#237;na reduce el inicio del bloqueo sensitivo y motor&#44; y aumenta la duraci&#243;n del bloqueo sensitivo y motor en el bloqueo supraclavicular del plexo braquial&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Das B&#44; Lakshmegowda M&#44; Sharma M&#44; Mitra S&#44; Chauhan R&#46; Bloqueo supraclavicular del plexo braquial con ropivaca&#237;na sola o en combinaci&#243;n con dexmedetomidina en cirug&#237;as de extremidades superiores&#58; ensayo comparativo&#44; prospectivo&#44; monitorizaci&#243;n y con doble enmascaramiento&#46; Rev Esp Anestesiol Reanim&#46; 2016&#59;63&#58;135&#8211;140&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R Group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RD Group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;2 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#47;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;33 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#46;85 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; confidence interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Onset of sensory block &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;75 &#40;2&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;75 &#40;2&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58&#8211;0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Duration of sensory block &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">379&#46;40 &#40;55&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">211&#46;60 &#40;47&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;65&#8211;1&#46;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;35 &#40;2&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;25 &#40;4&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65&#8211;0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Duration of motor block &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">312&#46;0 &#40;49&#46;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184&#46;7 &#40;36&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;56&#8211;1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Durantion of analgesia &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">413&#46;73 &#40;89&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">197&#46;35 &#40;28&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;93&#8211;2&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">No&#46; of patients requiring i&#46;v&#46; fentanyl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">No&#46; of patients requiring i&#46;v&#46; ketorolac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;87&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Postoperative somnolence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of dexmedetomidine along with bupivacaine for brachial plexus block"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Gandhi"
                            1 => "A&#46; Shah"
                            2 => "I&#46; Patel"
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                        ]
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                      "Revista" => array:5 [
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                        "volumen" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supraclavicular nerve block&#58; anatomic analysis of a method to prevent pneumothorax"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Brown"
                            1 => "D&#46;R&#46; Cahill"
                            2 => "L&#46;D&#46; Bridenbaugh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "volumen" => "76"
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                          0 => array:2 [
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                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brachial plexus anaesthesia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;B&#46;J&#46; Fischer"
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                      ]
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                      "LibroEditado" => array:5 [
                        "titulo" => "Principles and practice of regional anaesthesia"
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            3 => array:3 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute toxicity of ropivacaine compared with that of bupivacaine"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;B&#46; Scott"
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                            2 => "D&#46; Fagan"
                            3 => "P&#46; Bloomfield"
                            4 => "R&#46; Lundh"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Anesth Analg"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of the selectivity&#44; specificity and potency of medetomidine as an &#945;<span class="elsevierStyleInf">2</span>-adrenoceptor agonist"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Virtanen"
                            1 => "J&#46;M&#46; Savola"
                            2 => "V&#46; Saano"
                            3 => "L&#46; Nyman"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pharmacol"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2900154"
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                      "titulo" => "The effects of increasing plasma concentration of dexmedetomidine in humans"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;J&#46; Ebert"
                            1 => "J&#46;E&#46; Hall"
                            2 => "J&#46;A&#46; Barney"
                            3 => "T&#46;D&#46; Uhrich"
                            4 => "M&#46;D&#46; Colinco"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anaesthesiology"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Yoshitomi"
                            1 => "A&#46; Kohjitani"
                            2 => "S&#46; Maeda"
                            3 => "H&#46; Higuchi"
                            4 => "M&#46; Shimada"
                            5 => "T&#46; Miyawaki"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ane.0b013e318176be73"
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2008"
                        "volumen" => "107"
                        "paginaInicial" => "96"
                        "paginaFinal" => "101"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18635472"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;M&#46; Brummett"
                            1 => "M&#46;A&#46; Norat"
                            2 => "J&#46;M&#46; Palmisano"
                            3 => "R&#46; Lydic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block&#58; a systematic review and meta-analysis"
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