Dataset Information

A sequential allocation study to determine the ED₅₀ of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

ABSTRACT:

Background

Intravenous regional anesthesia is an easy and reliable anesthetic technique, but its use is limited by tourniquet pain. Clonidine is effective in overcoming this shortcoming when used with intravenous regional anesthesia at a dose of 1 μg/kg. Dexmedetomidine has also been used successfully at a dose of 0.5 μg/kg.

Objective

Based on the potency ratios of clonidine and dexmedetomidine (8 to 1) we hypothesize that a lower dexmedetomidine dose would provide patients with 50 min of pain free tourniquet time.

Methods

After informed consent, patients received intravenous regional anesthesia with lidocaine and dexmedetomidine following a sequential allocation scheme. The first patient received a dose of 0.5 μg/kg of dexmedetomidine. The dose was then adjusted in 0.1 μg/kg gradients for the following patients depending on the success of the previous block. If a patient experienced tourniquet pain prior to 50 min, the next patient received a higher dose. If not, the dose was decreased. Recruitment continued until 6 independent crossovers were observed with a minimum of 20 patients. The median effective dose ED₅₀ of dexmedetomidine was calculated using the modified up-and-down method.

Main outcome measures

The median effective dose of dexmedetomidine (ED₅₀) that provides 50 min of tolerance to the tourniquet during a lidocaine intravenous regional anesthesia by a sequential Dixon up-and-down allocation study.

Results

The ED₅₀ of dexmedetomidine that provided 50 min of tolerance to the tourniquet was 0.30 ± 0.06 μg/kg.

Conclusion

We determined that the dexmedetomidine dose necessary to provide 50 min of pain free tourniquet time during intravenous regional anesthesia was higher than expected based on the relative alpha-2 adrenergic receptor selectivity of dexmedetomidine compared to clonidine.

Trial registration

Clinicaltrials.gov: Retrospectively registered ( NCT05342870 ; registration date: 25/04/2022).

SUBMITTER: Karam C

PROVIDER: S-EPMC9137144 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A sequential allocation study to determine the ED<sub>50</sub> of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Karam Cynthia C Al Assadi Sadek S Kanazi Ghassan G Zeeni Carine C

BMC anesthesiology 20220527 1

<h4>Background</h4>Intravenous regional anesthesia is an easy and reliable anesthetic technique, but its use is limited by tourniquet pain. Clonidine is effective in overcoming this shortcoming when used with intravenous regional anesthesia at a dose of 1 μg/kg. Dexmedetomidine has also been used successfully at a dose of 0.5 μg/kg.<h4>Objective</h4>Based on the potency ratios of clonidine and dexmedetomidine (8 to 1) we hypothesize that a lower dexmedetomidine dose would provide patients with 5 ...[more]

PMID: 35624418

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Project description:ObjectivesHysterectomy or myomectomy is a common gynaecological procedure that results in moderate to severe acute postoperative pain, which can cause many adverse effects. This study aimed to compare the postoperative analgesic efficacy, opioid consumption, quality of postoperative recovery (QOR) and adverse reactions of intravenous coinjection of lidocaine and dexmedetomidine versus lidocaine or dexmedetomidine alone in gynaecological surgery.DesignSystematic review and meta-analysis was performed.Data sourcesThe PubMed, Embase, Cochrane Library and Web of Science databases were used to access the articles. Electronic databases were searched for eligible studies published before 1 May 2024.Eligibility criteriaAll randomised controlled trials (RCTs) were included in the final analysis in which the intraoperative intervention group received intravenous coinjection of lidocaine and dexmedetomidine, and the control group received intravenous injection of lidocaine or dexmedetomidine alone in gynaecologic procedures.Data extraction and synthesisStudy retrieval, literature screening, data extraction and risk of bias assessment were performed independently by two reviewers. The quality of included studies was assessed by the Cochrane Collaboration Risk of Bias (ROB V.2.0). Data were expressed as standardised mean difference, weighted mean difference or relative risk with 95% CI. Review Manager V.5.4 was used for data analysis.ResultsA total of five RCTs were included, involving 672 patients, of which 224 patients received coinjection of lidocaine and dexmedetomidine. The results revealed that coinjection of lidocaine and dexmedetomidine was superior to individual lidocaine in the visual analogue scale (VAS) scores at 1 hour (MD=-0.90, 95% CI (-1.11 to -0.69), p<0.001), 2 hours (MD=-0.99, 95% CI (-1.19 to -0.80), p<0.001), 4 hours (MD=-1.20, 95% CI (-1.75 to -0.66), p<0.001), 6 hours (MD=-1.09, 95% CI (-1.48 to -0.70), p<0.001), 8 hours (MD=-1.22, 95% CI (-1.61 to -0.83), p<0.001) and 12 hours (MD=-0.76, 95% CI (-1.35 to -0.17), p=0.o1) after surgery. Compared with the dexmedetomidine group, the lidocaine+dexmedetomidine group had low VAS scores at 1 hour (MD=-0.60, 95% CI (-0.83 to -0.37), p<0.001), 2 hours (MD=-0.70, 95% CI (-0.87 to -0.53), p<0.001), 6 hours (MD=-0.79, 95% CI (-0.98 to -0.59), p<0.001), 8 hours (MD=-0.77, 95% CI (-1.25 to -0.28), p=0.002) and 12 hours (MD=-0.56, 95% CI (-1.00 to -0.11), p=0.01) after surgery. Coinjection of lidocaine and dexmedetomidine resulted in significantly lower postoperative opioid consumption, postoperative nausea and vomiting and bradycardia than lidocaine alone (all p<0.05). Compared with the dexmedetomidine group, the lidocaine+dexmedetomidine group shortened the time to intestinal transit resumption (p=0.003). Coinjection of lidocaine and dexmedetomidine reduced intraoperative opioid consumption and increased QOR scores compared with lidocaine and dexmedetomidine alone (all p<0.05).ConclusionLidocaine combined with dexmedetomidine had superior analgesic efficacy and safety. However, due to the limitation in the number of available studies, more large-scale, prospective RCTs are needed for further investigation.PROSPERO registration numberCRD42023384018.

Project description:Background and aimTotal intravenous anesthesia (TIVA) has proven advantage over inhalational anesthesia in terms of stable hemodynamic, eco-friendly, and good recovery profile, but apprehension regarding adequate depth of anesthesia and intraoperative recall is still pertaining. This study aims to compare propofol-dexmedetomidine-based TIVA with sevoflurane-based inhalational anesthesia in modified radical mastectomy in terms of depth of anesthesia, intraoperative recall, recovery profile, and hemodynamic status.Settings and designThis prospective randomized controlled study was conducted at a tertiary care center over a time frame of 1 year.MethodologyIn this randomized controlled study, 100 patients were randomly distributed into two groups: TIVA (Group T) and inhalational anesthesia (Group I). Group T patients received injection dexmedetomidine: 1 μg.kg-1 over 10 min followed by 0.7 μg.kg-1.h-1 and injection propofol: 25-100 μg.kg-1.min-1. Ventilation was maintained with oxygen-air gas flow. In Group I, patients were ventilated with nitrous oxide-oxygen (50:50) and sevoflurane. Rest of anesthesia for both the groups was same. Primary objective was to achieve adequate depth of anesthesia as monitored by intraoperative bispectral index value (BIS, 40-60). Hemodynamic variables, recovery profile, and amount of individual anesthetic agent consumed were recorded for comparison between two groups. For comparison of scale variables between two groups, independent sample t-test for significant difference between two sample means has been followed.ResultsIntraoperative BIS and hemodynamic variables were comparable (P > 0.05). Emergence time was 5.10 min in the TIVA group versus 8.38 min in the inhalational group (P = 0.00). Modified Aldrete score was comparable in two groups (P > 0.05). Cost of TIVA agents consumed per patient was 40% lesser than inhalational agents.ConclusionTIVA maintains adequate depth of anesthesia along with stable hemodynamic and good recovery profile, at low cost in an eco-friendly manner.

Dataset Information

A sequential allocation study to determine the ED₅₀ of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Background

Objective

Methods

Main outcome measures

Results

Conclusion

Trial registration

Publications

A sequential allocation study to determine the ED<sub>50</sub> of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

A sequential allocation study to determine the ED50 of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Background

Objective

Methods

Main outcome measures

Results

Conclusion

Trial registration

Publications

A sequential allocation study to determine the ED<sub>50</sub> of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

A sequential allocation study to determine the ED₅₀ of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.