Effect of Perineural Dexmedetomidine on the ED50 Ropivacaine for Brachial Plexus Blocks in Pediatric Patients: a Randomized Trial
- Registration Number
- NCT02781246
- Lead Sponsor
- Guangzhou Women and Children's Medical Center
- Brief Summary
Dexmedetomidine can prolong the duration of local anesthetics, but the effect of perineural dexmedetomidine on the potency of ropivacaine for brachial plexus blocks in pediatric patients has not been investigated. This study was designed to determine the effect of perineural dexmedetomidine on ropivacaine for brachial plexus blocks in pediatric patients
- Detailed Description
150 children scheduled for arm and forearm surgery underwent supraclavicle brachial plexus blocks with ropivacaine guided by ultrasound visualisation were randomly assigned to one of the five groups: Group A (perineural ropivacaine), Group B (ropivacaine plus 0.5 mcg/kg dexmedetomidine), Group C (ropivacaine plus 1 mcg/kg dexmedetomidine), Group D (ropivacaine plus 1.5mcg/kg dexmedetomidine) and Group E (ropivacaine plus 2 mcg/kg dexmedetomidine). The primary endpoint was the minimum local anesthetic concentration (MLAC), which was determined using the Dixon up-and-down method. The secondary endpoints were the duration of analgesia and sedation
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 160
- ASA I,II children, aged between 2 and 6 years, who were scheduled for arm and forearm surgery underwent supraclavicular brachial plexus blocks.
- any subjects with neurological, neuromuscular, psychiatric, or blood clotting disorders, or known history of active and severe renal, hepatic, respiratory, or cardiac diseases, or known allergy to systemic or local anesthetics or dexmedetomidine
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description saline (Group A) perineural dexmedetomidine perineural ropivacaine 0.5 mcg/kg dexmedetomidine (Group B) perineural dexmedetomidine (perineural ropivacaine plus 0.5 mcg/kg dexmedetomidine), 1 mcg/kg dexmedetomidine (Group C) perineural dexmedetomidine (perineural ropivacaine plus 1 mcg/kg dexmedetomidine) 2 mcg/kg dexmedetomidine (Group E) perineural dexmedetomidine (perineural ropivacaine plus 2 mcg/kg dexmedetomidine) 1.5 mcg/kg dexmedetomidine (Group D) perineural dexmedetomidine (perineural ropivacaine plus 1.5mcg/kg dexmedetomidine)
- Primary Outcome Measures
Name Time Method Postoperative pain up to 12 hours after brachial plexus blocks The Face, Legs, Activity, Cry, Consolability scale or FLACC scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain.
The scale is scored in a range of 0-10 with 0 representing no pain, 1-3 representing mild uncomfortable, 4-6 representing moderate pain, 7-10 representing high-level pain or/and uncomfort. The FLACC scale was evaluated at 6 and 12 hours postoperatively, and scale of ≥4 points was regarded as an inadequate analgesia and was managed with 10 mg/kg of ibuprofen by mouth every 6 h as requiredthe minimum local anesthetic concentration (MLAC) up to 30 minutes after brachial plexus blocks For each patient, the target concentration of perineural ropivacaine was determined using the modified Dixon's up-and-down method starting with 0.20% in each group, varied with 0.1% as a step size. Increasing or decreasing the target concentration of perineural ropivacaine was determined by the response of the previous child in the same group. The response of each child was observed for 60 s after the skin incision and evaluated as 'successful' or 'unsuccessful.' 'Unsuccessful' was recorded when skin incision caused motor responses or change in hemodynamic parameters (heart rate and mean blood pressure) more than 20% of the preincision values. If the response was determined to be unsuccessful, the concentration of perineural ropivacaine given to the next patient would be increased by 0.1%. If it was successful, the concentration of caudal levobupivacaine given to the next patient would be decreased by 0.1%
The sedation status up to 12 hours after brachial plexus blocks Sedation status was evaluated by a attending anesthesiologists with a 6-point sedation scale, which was modified from the Modified Observer Assessment of Alertness and Sedation Scale (MOAA/S). The MOAA/S scale was evaluated at 6 and 12 hours postoperatively
0 Does not respond to a noxious stimulus
1. Does not respond to mild prodding or shaking
2. Responds only after mild prodding or shaking
3. Responds only after name is called loudly or repeatedly
4. Lethargic response to name-spoken in normal tone
5. Appears asleep, but responds readily to name-spoken in normal tone
6. Appears alert and awake, responds readily to name-spoken in normal tone
- Secondary Outcome Measures
Name Time Method noninvasive arterial blood pressure up to 12 hours after brachial plexus blocks Hypotension was defined as a reduction in systolic blood pressure more than 20% from the baseline values
pulse oximetry up to 12 hours after brachial plexus blocks Significant Oxyhemoglobin desaturation was defined as \< 90%
heart rate up to 12 hours after brachial plexus blocks Bradycardia was defined as a reduction in heart rate more than 20% from the baseline values