Search In this Thesis
   Search In this Thesis  
العنوان
Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Peripheral Nerve Block:
المؤلف
Nassif, George Maher.
هيئة الاعداد
باحث / George Maher Nassif
مشرف / Bassel Mohamed Essam Nor El-Din
مشرف / Hesham Mohammed Mahmoud El-azzazi
مناقش / Fady Adib Abdel-Malek
تاريخ النشر
2019.
عدد الصفحات
142 P. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
التخدير و علاج الألم
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم التخدير والرعاية المركزة
الفهرس
Only 14 pages are availabe for public view

from 142

from 142

Abstract

Poorly controlled acute pain after surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.
Brachial plexus is a complex network of nerves supplying the whole upper limb, including it’s motor and sensory supply. Arising from the neck, passing through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. Supraclavicular brachial plexus block is frequently used for upper limb surgeries
The paravertebral space contains dorsal and ventral rami and the sympathetic chain. Thoracic Paravertebral nerve block is used for breast surgeries either a single modality or as adjuvant to general anesthesia. It involves injection of local anesthetic at the site where the spinal nerve emerges from the intervertebral foramina. Hence. results in unilateral sensory, motor and sympathetic blockade.
Also, femoral nerve block is frequently used for lower limb surgeries.
The growing importance and clinical application of the ultrasound in clinical practice of anesthesia and regional nerve block is the idea of pre-emptively scanning patient anatomy for neurovascular variations or abnormalities has been suggested as a means of improving patient safety by preventing block complication like pneumothorax, hematoma formation, improper block or intravascular injection.
Clinically, α2-adrenoceptor agonists such as dexmedetomidine are widely used as sedative agents, as adjuncts to anesthesia and have been noted to produce a good analgesic effects. Dexmedetomidine is a potent analgesic but the accompanying sedation and hypotension produced by systemic administration has limited the widespread deployment of α2-agonists as analgesics and prompted investigations to separate these effects.
Recent studies have shown, based on current evidence, that perineural dexmedetomidine as an adjuvant to local anesthetics for peripheral nerve blocks can prolong the duration of the blockade and postoperative analgesia.
So perineural dexmedetomidine is used as a promising adjuvant to extend the duration of long-acting local anesthetics. With a good balance between block duration, hemodynamic side effects and sedation
The aim of this study was to compare the effects of adding 100 micro-gram of dexmedetomidine to bupivacaine in different ultrasound-guided nerve blocks, as regards the onset and the duration of the sensory and motor block, and the duration of post-operative analgesia, sedative effect and their effect on reduction of the post-operative analgesic requirement, as well as monitoring the occurrence of any complication.
Sixty patients of either sex, ASA I and II status were enrolled in this study. They were classified into 3 equal divisions [different nerve blocks: supraclavicular block, thoracic PVB, and Femoral nerve block] each is divided into two equal groups:
group 1 (control group):10 patients received a total volume of 31 ml [30 ml bupivacaine. plus 1 ml normal saline].
group 2 (Dexmedetomidine group): 10 patients received a total volume of 31 ml [30 ml bupivacaine plus 100 micrograms of dexmedetomidine (1 ml of commercially available drug form)].
All the patients completed the study.
This study showed that addition of a 100 micro gram of dexmedetomidine to bupivacaine in these nerve blocks shortens the onset times of sensory block and motor block and significantly prolongs their duration and decreases the amount of total post-operative analgesic requirements in comparison to bupivacaine alone, also dexmedetomidine got an added effect of conscious sedation with minimal side effects, that makes it more superior in the previously used doses.