Dexmedetomidine in addition to Ropivacaine for Femoral Nerve Block inhibits the Local Inflammatory Response

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SCIENCE
Dexmedetomidine in addition to Ropivacaine for Femoral Nerve Block inhibits the Local Inflammatory Response
Key Take-Away: 

A peripheral nerve block is widely recommended in the management of post-operative pain after total knee arthroplasty. Dexmedetomidine as an adjunct therapy to ropivacaine is an effective measure for inhibition of inflammation causing postoperative pain after total knee arthroplasty.

Peripheral nerve block has shown to possess an anti-inflammatory effect in animal studies, while inconclusive in human studies. Dexmedetomidine (DEX), a highly selective α2-adrenoceptor agonist, has a potent anti-inflammatory effect. 

ABSTRACT: 
Background: 

Peripheral nerve block has shown to possess an anti-inflammatory effect in animal studies, while inconclusive in human studies.

Dexmedetomidine (DEX), a highly selective α2-adrenoceptor agonist, has a potent anti-inflammatory effect. The objective of the study was to evaluate the effect of DEX as an adjunct therapy to ropivacaine for femoral nerve block (FNB) on local inflammatory response after total knee arthroplasty (TKA).

Methods: 

Sixty patients scheduled for TKA were randomized into two equal groups in a prospective randomized study. All participants were all treated with FNB preoperatively.

Two groups were divided as group R (20 mL of 0.5% ropivacaine were injected for the block) and group RD (20 mL of 0.5% ropivacaine plus 1 µg/kg DEX).  Visual Analog Scale (VAS), the circumference of the operated knee, and the concentration of interleukin-6 (IL-6) and prostaglandin E2 (PGE2) in joint fluid were evaluated. Adverse events such as hypotension, bradycardia, and hypoxia were also recorded.

Results: 

The VAS was lower in group RD for 12 to 48 hours after the surgery (p<0.03).

Knee circumference was smaller in group RD at each time point after surgery (p<0.05). PGE2 in joint fluid in group RD was lower at 6, 12, 24, and 48 hours after surgery (P<0.02), IL-6 was lower at 12, 24, and 48 hours after surgery (p<0.03). No adverse events were observed.
 

Conclusion: 

Adding 1 µg/kg DEX to ropivacaine for femoral nerve block shown to have a significant inhibitory effect on local inflammatory response and showed superior postoperative pain control as compared to ropivacaine alone after TKA.

 

Source:

Minerva  Anestesiologica

Link to the source:

http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2017N06A0590

The original title of the article:

Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits the local inflammatory response

Authors:

Jing LI et al.

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