engleski

Dexmedetomidine as an adjuvant to levobupivacaine and lidocaine in ultrasound-guided superficial cervical block for carotid endarterectomy: a prospective, randomised, doubleblinded study

Background and Goal of Study: Numerous additives were tried in combination with local anaesthetics to increase the quality of anaesthesia and prolong postoperative analgesia. Research on use of a-2- receptor agonist dexmedetomidine as an adjuvant in regional anaesthesia has positive effect on duration of block, but there are no studies on usage in superficial cervical block (SCB) in carotid endarterectomy (CEA), where management of mean arterial pressure is essential. We therefore designed a prospective, randomised, double-blinded study to investigate the effect of adding dexmedetomidine to levobupivacaine and lidocaine on the quality of SCB in CEA surgery. Materials and Methods:Ultrasound-guided SCB was performed on thirty-three ASA Grade II and III patients undergoing elective CEA surgery. Patients did not receive any premedication. All patients had invasive blood pressure monitoring and parameters were noted every 5 minutes. Patients were randomly assigned into two groups: both groups received 2 mg/kg 0.5% levobupivacaine with 200 mg of 2% lidocaine supplemented with saline to a volume of 50 mL. Subject group S additionally received 50 micrograms of dexmedetomidine in mixture. The onset and duration of sensory block and analgesia, haemodynamic parameters and side effects: bradycardia, hypotension, respiratory depression, nausea, vomiting, pruritus and shivering were recorded. Results and Discussion: Demographic data and surgical characteristics were comparable in both groups. The time to first analgesia was significantly higher in Group S (N=16) vs control Group C (N=17) (median 920 [IQR 503] vs. 590 [IQR 210]) minutes respectively, Mann-Whitney p=0.032). There was no significant difference in block onset times or duration of sensory block between groups. The log-rank test indicated a significant difference in the Kaplan- Meier curves for the time to VAS ≤3 (p=0.038). There was no difference in incidence of side-effects and hemodynamic parameters. Conclusion(s): Addition of 50 mcg of dexmedetomidine to 0.5% levobupivacaine and 2% lidocaine for SCB does not increase the duration of SCB, but increases the time to first request of rescue analgesia and increases the probability of VAS ≤3 in the postoperative period, without influence on haemodynamics and frequency of side- effects.

Anaesthetic techniques ; regional ; Surgery ; vascular ; Sympathetic nervous system , dexmedetomidine

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