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The effect of dexmedetomidine in addition to local anaesthetic on the block of nerves in the arm
ISRCTN ISRCTN67622282
DOI 10.1186/ISRCTN67622282
ClinicalTrials.gov identifier
EudraCT number
Public title The effect of dexmedetomidine in addition to local anaesthetic on the block of nerves in the arm
Scientific title Effects of dexmedetomidine addition to levobupivacaine in axillary brachial plexus blockade
Acronym N/A
Serial number at source N/A
Study hypothesis We hypothesized that dexmedetomidine addition will prolong the duration of anesthesia and analgesia with a shorter onset time
Lay summary Lay summary under review 4
Ethics approval Cumhuriyet University Ethics Committee, Turkey, 04 April 2007, ref: 2007-4/4
Study design Randomized controlled double blind prospective trial
Countries of recruitment Turkey
Disease/condition/study domain Anaesthesia and analgesia in the arm
Participants - inclusion criteria 1. Aged 18-60 years old
2. Male and female participants
3. Scheduled forearm and hand surgery patients
Participants - exclusion criteria 1. Patients with a history of cardiac, respiratory, hepatic, or renal failure, coagulopathy, and allergy to amid local anesthetics
2. Receiving adrenoreceptor agonist or antagonist therapy, chronic analgesic therapy
3. Pregnant women
Anticipated start date 20/11/2011
Anticipated end date 28/02/2012
Status of trial Completed
Patient information material Not available in web format, please use the contact details below to request a patient information sheet
Target number of participants 64
Interventions In this study we aimed to investigate the effects of dexmedetomidine addition to levobupivacaine in axillary brachial plexus block. We hypothesized that dexmedetomidine addition will prolong the duration of anesthesia and analgesia with a shorter onset time

Control group received local anesthetic drug without adjuvant drug

The patients were divided into two groups randomly:
Group L (n=32): Levobupivacaine (Chirocaine, 5 mg/mL; Abbott Lab/Turkey) with isotonic sodium chloride.
Group D (n=32): Levobupivacaine and dexmedetomidine (Precedex 200 mcg / 2 mL, Meditera, Turkey) with isotonic sodium chloride. The randomization was achieved by random number table. The drug solutions were prepared by an anesthesiologist that was not involved in the study.

The patients were monitored for their mean arterial blood pressures (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) in the operation room before the blockage ande baseline values were recorded. All patients were not given any premedications. After insertion of a 20-gauge intravenous (IV) catheter in a peripheral vein in the contralateral arm, axillary block was performed with the patient in the supine position and the upper arm with 90° abduction and the elbow with 110° flexion. During the application, a nerve stimulator (Stimuplex, Braun, Germany) was used for the nerve localization. For blockage, 22G, 50 mm stimulating needle (Stimuplex D, B.Braun Melsungen AG, Japan) was used. The stimulator was adjusted to 1.0 mA, 2 Hz, 0.1 ms parameters at the beginning of the procedure. The location of the needle was accepted adequate when an output current < 0.5 mA caused a slight distal motor response. After the localization of radial, ulnar, median and musculocutaneous nerves, group L (n=32) patients were given a total 40 mL solution of 39 mL levobupivacaine 0.5% with 1 mL of isotonic sodium chloride solution, and group D (n=32) patients were given a total 40mL solution of 39 mL levobupivacaine 0.5% with 1 mL volume of 1 µg kg-1 dexmedetomidine plus isotonic sodium chloride solution in a double-blind mode. We used a multi-stimulation technique in all of the patients of both groups. Anesthetic mixture (10 mL for each nerve = 40 mL) were injected after identifying the radial, ulnar, median and musculocutaneous nerves in each patient. During injection, negative aspiration was performed every 3.04.0 ml to avoid intravascular injection. If there was any blockade failure in a nerve distribution region, even if the block was adequate for the surgery, the patients were excluded from the study. All axillary brachial plexus blocks were performed by the same anesthesiologist.

Sensory and motor blockades of median, radial, ulnar, and musculocutaneous nerves, and HR, MAP, SpO2 values were recorded after 5, 10, 20, 30, 60, 80 min from the blockade and 10, 30 min, 1, 2, 4, 6, 12 hours after the end of the surgery. Sensory blockade of each nerve was assessed by pinprick test. Sensory blockade was rated by the patient on a verbal analog scale from 100 (normal sensation) to 0 (no sensation). Motor block was evaluated by thumb adduction (ulnar nerve), thumb abduction (radial nerve), flexion of the elbow and pronation of forearm (musculocutaneous), and thumb opposition (median nerve). Motor block evaluation were performed using a modification of the Levvott rating scale from 6 (normal muscular force) to 0 (complete paralysis).
The onset time of the sensory and motor blockades was defined as the time between the end of the local anesthetic injection and no response to the pinprick test and complete paralysis. The duration of sensory block was considered as the time interval between the complete sensory block and the first postoperative pain, and the duration of motor block was defined as the time interval between the complete paralysis and complete recovery of motor function. Time to first analgesic use and total need for analgesics were recorded during postoperative first 12 hours. Postoperative pain levels were evaluated by a 10 cm visual analog scale (VAS) from 0 (no pain) to 10 (severe pain). Hypotension (a 20% decrease from the baseline value), bradycardia (HR < 50 beats per minute), hypoxemia (SpO2 < 90%), nausea and vomiting occurrences were also recorded. If there were hypotension, bradycardia and hypoxemia, it was planned to administrate ephedrine 10 mg IV, atropine 1mg IV and 4-5 l h-1 O2 inhalation therapy respectively. If VAS values were above 4 the patient was given intramuscular (IM) diclofenac 75 mg. The anesthesiologist who evaluated the blockade responses and the patients were blinded as to the solution used.
Primary outcome measure(s) 1. Sensory and motor block onset time
2. Sensory and motor block durations
3. Time to first analgesic use
Secondary outcome measure(s) 1. Mean arterial pressure
2. Heart rate
Sources of funding Investigator initiated and funded (Turkey)
Trial website
Publications
Contact name Dr  Kenan  Kaygusuz
  Address Cumhuriyet University School of Medicine
Department of Anesthesiology
  City/town Sivas
  Zip/Postcode 58140
  Country Turkey
  Email kaygusuzkenan@gmail.com
Sponsor Cumhuriyet University (Turkey)
  Address School of Medicine Research Hospital
  City/town Sivas
  Zip/Postcode 58140
  Country Turkey
  Email cevdetduger@gmail.com
  Sponsor website: http://www.cumhuriyet.edu.tr
Date applied 15/12/2011
Last edited 10/02/2012
Date ISRCTN assigned 10/02/2012
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