Issue
Application of dexmedetomidine combined with ropivacaine in axillary brachial plexus block in children and its effect on inflammatory factors
Corresponding Author(s) : Bo Wang
Cellular and Molecular Biology,
Vol. 66 No. 5: Issue 5
Abstract
This study aimed to investigate the effect of dexmedetomidine combined with ropivacaine on inflammatory factors in children with axillary brachial plexus block. Ninety patients who underwent upper limb surgery in our hospital from January 2017 to December 2018 were enrolled and divided into groups A and B. Group A (n=40) was treated with ropivacaine as a local anesthetic, and group B (n= 50) was treated with dexmedetomidine combined with ropivacaine as a local anesthetic during surgery. Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale was employed to evaluate the pain behavior of the children. Intravenous blood (3 ml) was taken before surgery (T0), 30 min (T1) and 3 hours after surgery (T2) respectively to detect serum TNF-α (tumor necrosis factor-α), IL-6 (interleukin-6) and IL-1β (interleukin-1β) levels using ELISA. The adverse reactions in the two groups were observed, and the MAP (mean arterial pressure) and HR (heart rate) were compared before anesthesia, 30 min and 1 hour after block. The FLACC score of both groups showed a marked upward trend (p< 0.001), with that of group B being significantly lower than group A (p< 0.001). Group B presented a remarkably shorter onset time than group A, and the analgesic time was significantly longer (p< 0.001). The incidence of adverse reactions in group B was significantly lower than that in group A (p< 0.05). MAP and HR dropped significantly 30 min and 1 h after block (p< 0.05). MAP and HR were significantly lower in group B than those in group A 30 min and 60 min after block (p< 0.05). As to serum levels of TNF-α, IL-6, and IL-1β, both groups presented notably increased ones after block (p< 0.05). The application of dexmedetomidine combined with ropivacaine in upper limb surgery has a faster onset time and longer duration than ropivacaine alone, which is of certain clinical effect.
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- Hong B, Jung C, Jo Y. Postoperative pain control by ultrasound guided brachial plexus block reduces emergence delirium in pediatric patients. Anesth Pain Med 2019; 14: 280-287.
- Kilgore KL and Bhadra N. Alleviates the onset of high frequency nerve block: US Patent 2015; 8, 983, 614.
- Chin KJ, Cubillos JE and Alakkad H. Single, double or multiple injection technique for subgingival brachial plexus block in non-ultrasound guided lower arm surgery. Journal of Practical Preventive Medicine. Cochrane Database Syst Rev 2016; 9: CD003842.
- Lee MJ, Koo DJ, Choi YS, Lee KC, Kim HY. dexamethasone, dexmedetomidine, ultrasound-guided brachial plexus block with nerve stimulation. Korean J Pain 2016; 29: 29.
- Fang P, Zong Z, Lu Y. Ropivacaine, local anesthesia, effect on tracheal intubation response: a prospective randomized double-blind controlled study. BMC Anesthesiol 2018; 18: 134.
- Markham AD. Ropivacaine. Drugs 1996; 52: 429-449.
- Venkatesh RR, Kumar P, Trissur RR, George SK. A Randomized Controlled Study of 0.5% Bupivacaine, 0.5% Ropivacaine and 0.75% Ropivacaine for Supraclavicular Brachial Plexus Block. J Clin Diagn Res 2016; 10: UC09.
- Chen C, You P. A novel local anesthesia system: a transcriptional transactivator-modified nanocarrier can be used for skin delivery of ropivacaine. Drug Des Devel Ther 2017; 11: 1941.
- Das B, Lakshmegowda M, Sharma M, Mitra S, Chauhan R. Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study. Rev Esp Anestesiol Reanim 2016; 63: 135-140.
- El-Boghdadly K, Brull R, Sehmbi H, Abdallah FW. Perineural Dexmedetomidine Is More Effective Than Clonidine When Added to Local Anesthetic for Supraclavicular Brachial Plexus Block: A Systematic Review and Meta-analysis. Anesth Analg 2017; 124: 2008-2020.
- Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, Patel R, Oh J, Brull R. Intramuscular groove brachial plexus block, randomized, three-arm, three-cap, placebo-controlled trials, intravenous and right-handed dexmedetomidine similarly prolonged analgesia time. Anesthesiology 2016; 124: 683-695.
- Mahmoud M, Mason KP. Dexmedetomidine: Review, update and future considerations of perioperative and perioperative applications and limitations in pediatrics. Br J Anaesth 2015; 115: 171-182.
- Singh AP, Mahindra M, Gupta R, Bajwa SJ. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach. Anesth Essays Res 2016; 10: 414.
- Kwon Y, Hwang SM, Lee JJ, Kim JH. The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block. Korean J Anesthesiol 2015; 68: 32.
- Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg 2002; 95: 1224-1229.
- Sharan R, Verma R, Dhawan A, Kumar J. Comparison of clonidine and fentanyl as adjuvant to ropivacaine in spinal anesthesia in lower abdominal surgeries. Anesth Essays Res 2016; 10: 526.
- Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015; 9: 148-154.
- Kirksey MA, Haskins SC, Cheng J, Liu SS. Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 2015; 10: e0137312.
- Liu Z, Jiang M, Xu T, Hua H. Analgesic effect of ropivacaine combined with dexmedetomidine on brachial plexus block. BMC Anesthesiol 2018; 18: 107.
- Albrecht E, Vorobeichik L, Jacot-Guillarmod A, Fournier N, Abdallah FW. Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block: Systematic Review and Indirect Meta-analysis. Anesth Analg 2019; 128: 543-554.
- Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet 2017; 56: 893-913.
- Jones HG, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans MD, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Colorectal Dis 2018; 33: 857-862.
- Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69(4): 1198-204.
- Cruz FF, Rocco PRM, Pelosi P. Anti-inflammatory properties of anesthetics. J Phys Chem 2011; 27: 1097-1910.
- Huang Y, Lu Y, Zhang L, Yan J, Jiang J, Jiang H. Perineural dexmedetomidine attenuates inflammation in rat sciatic nerve via the NF-κB pathway. Int J Mol Sci 2014; 15: 4049-4059.
- Nie Y, Luo F, Wang L, Yang T, Shi L, Li X, Shen J, Xu W, Guo T, Lin Q. Anti-hyperlipidemic effect of rice bran polysaccharide and its potential mechanism in high-fat diet mice. Food Func 2017; 8(11): 4028-4041.
- Ren Y, Jiao X, Zhang L. Expression level of fibroblast growth factor 5 (FGF5) in the peripheral blood of primary hypertension and its clinical significance. Saudi J Biol Sci 2018; 25(3): 469-473.
- Bordbar M, Darvishzadeh R, Pazhouhandeh M, Kahrizi D. An overview of genome editing methods based on endonucleases. Modern Genetics J 2020; 15(2): 75-92.
- Wang L, Lin Q, Yang T, Liang Y, Nie Y, Luo Y, Shen J, Fu X, Tang Y, Luo F. Oryzanol Modifies High Fat Diet-Induced Obesity, Liver Gene Expression Profile, and Inflammation Response in Mice. J Agri Food Chem 2017; 65(38): 8374-8385.
- Zhang T, Wu X, Shaheen SM, Zhao Q, Liu X, Rinklebe J, Ren H. Ammonium nitrogen recovery from digestate by hydrothermal pretreatment followed by activated hydrochar sorption. Chem Eng J 2020; 379: 1-54.
- Zhu B, Pang R, Chevallier J, Wei YM, Vo DT. Including intangible costs into the cost-of-illness approach: a method refinement illustrated based on the PM2.5 economic burden in China. Europ J Health Econ 2019; 20(4): 501-511.
- Chen H, Chen Y, Yang L. Intelligent early structural health prognosis with nonlinear system identification for RFID signal analysis. Comput Commun 2020; 157: 150-161.
- Yang M, Abdalrahman H, Sonia U, Mohammed A, Vestine U, Wang M, Ebadi AG, Toughani M. The application of DNA molecular markers in the study of Codonopsis species genetic variation, a review. Cell Mol Biol 2020; 2: 23-30.
- He L, Fang H, Wang X, Wang Y, Ge H, Li C, Chen C, Wan Y, He H. The 100 most-cited articles in urological surgery: A bibliometric analysis. Int J Surg 2020; 75: 74-79
- Chen HX, Huang L, Yang L, Chen YT, Huang JM. Model-based method with nonlinear ultrasonic system identification for mechanical structural health assessment. Trans Emerge Telecommun Technol 2020; 1-15.
- Chen X, Xu Y, Meng L, Chen X, Yuan L, Cai Q, Shi W, Huang G. Non-parametric partial least squares-discriminant analysis model based on sum of ranking difference algorithm for tea grade identification using electronic tongue data. Sens Actuators B Chem 2020; 311:127924-127931.
- Guo T, Lin Q, Li X, Nie Y, Wang L, Shi L, Xu W, Hu T, Guo T, Luo F. Octacosanol Attenuates Inflammation in Both RAW264.7 Macrophages and a Mouse Model of Colitis. J Agri Food Chem 2017; 65(18): 3647-3658.
- Jiang X, Zhu B, Chevallier J, Xie R. Allocating provincial CO2 quotas for the Chinese national carbon program. Australian J Agri Res Econ 2018; 62(3): 457-479.
- Li W, Jia MX, Wang JH, Lu JL, Deng J, Tang JX, Liu, C. Association of MMP9-1562C/T and MMP13-77A/G Polymorphisms with Non-Small Cell Lung Cancer in Southern Chinese Population. Biomolecules 2019; 9(3): 107-119.
- Liang Y, Lin Q, Huang P, Wang Y, Li J, Zhang L, Cao J. Rice Bioactive Peptide Binding with TLR4 To Overcome H2O2-Induced Injury in Human Umbilical Vein Endothelial Cells through NF-kappa B Signaling. J Agri Food Chem 2018; 66(2): 440-448.
- Lou Y, Guo D, Zhang H, Song L. Effectiveness of mesenchymal stems cells cultured by hanging drop vs. conventional culturing on the repair of hypoxic-ischemic-damaged mouse brains, measured by stemness gene expression. Open Life Sci 2016; 11(1): 519-523.
- Lou Y, Shi J, Guo D, Qureshi AK, Song L. Function of PD-L1 in antitumor immunity of glioma cells. Saudi J Biol Sci 2017; 24(4): 803-807.
- Lou Y, Yang J, Wang L, Chen X, Xin X, Liu Y. The clinical efficacy study of treatment to Chiari malformation type I with syringomyelia under the minimally invasive surgery of resection of Submeningeal cerebellar Tonsillar Herniation and reconstruction of Cisterna magna. Saudi J Biol Sci 2019; 26(8): 1927-1931.
- Uslu M, Kaya E, Yaykasli KO, Oktay M, Inanmaz ME, Isık C, Erdem H, Erkan ME, Kandis H. Erythropoietin Stimulates Patellar Tendon Healing in Rats, Knee 2015; 22(6): 461-468.
- Nie Y, Luo F, Lin Q. Dietary nutrition and gut microflora: A promising target for treating diseases. Trends Food Sci Technol 2018; 75: 72-80.
References
Hong B, Jung C, Jo Y. Postoperative pain control by ultrasound guided brachial plexus block reduces emergence delirium in pediatric patients. Anesth Pain Med 2019; 14: 280-287.
Kilgore KL and Bhadra N. Alleviates the onset of high frequency nerve block: US Patent 2015; 8, 983, 614.
Chin KJ, Cubillos JE and Alakkad H. Single, double or multiple injection technique for subgingival brachial plexus block in non-ultrasound guided lower arm surgery. Journal of Practical Preventive Medicine. Cochrane Database Syst Rev 2016; 9: CD003842.
Lee MJ, Koo DJ, Choi YS, Lee KC, Kim HY. dexamethasone, dexmedetomidine, ultrasound-guided brachial plexus block with nerve stimulation. Korean J Pain 2016; 29: 29.
Fang P, Zong Z, Lu Y. Ropivacaine, local anesthesia, effect on tracheal intubation response: a prospective randomized double-blind controlled study. BMC Anesthesiol 2018; 18: 134.
Markham AD. Ropivacaine. Drugs 1996; 52: 429-449.
Venkatesh RR, Kumar P, Trissur RR, George SK. A Randomized Controlled Study of 0.5% Bupivacaine, 0.5% Ropivacaine and 0.75% Ropivacaine for Supraclavicular Brachial Plexus Block. J Clin Diagn Res 2016; 10: UC09.
Chen C, You P. A novel local anesthesia system: a transcriptional transactivator-modified nanocarrier can be used for skin delivery of ropivacaine. Drug Des Devel Ther 2017; 11: 1941.
Das B, Lakshmegowda M, Sharma M, Mitra S, Chauhan R. Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study. Rev Esp Anestesiol Reanim 2016; 63: 135-140.
El-Boghdadly K, Brull R, Sehmbi H, Abdallah FW. Perineural Dexmedetomidine Is More Effective Than Clonidine When Added to Local Anesthetic for Supraclavicular Brachial Plexus Block: A Systematic Review and Meta-analysis. Anesth Analg 2017; 124: 2008-2020.
Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, Patel R, Oh J, Brull R. Intramuscular groove brachial plexus block, randomized, three-arm, three-cap, placebo-controlled trials, intravenous and right-handed dexmedetomidine similarly prolonged analgesia time. Anesthesiology 2016; 124: 683-695.
Mahmoud M, Mason KP. Dexmedetomidine: Review, update and future considerations of perioperative and perioperative applications and limitations in pediatrics. Br J Anaesth 2015; 115: 171-182.
Singh AP, Mahindra M, Gupta R, Bajwa SJ. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach. Anesth Essays Res 2016; 10: 414.
Kwon Y, Hwang SM, Lee JJ, Kim JH. The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block. Korean J Anesthesiol 2015; 68: 32.
Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg 2002; 95: 1224-1229.
Sharan R, Verma R, Dhawan A, Kumar J. Comparison of clonidine and fentanyl as adjuvant to ropivacaine in spinal anesthesia in lower abdominal surgeries. Anesth Essays Res 2016; 10: 526.
Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015; 9: 148-154.
Kirksey MA, Haskins SC, Cheng J, Liu SS. Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 2015; 10: e0137312.
Liu Z, Jiang M, Xu T, Hua H. Analgesic effect of ropivacaine combined with dexmedetomidine on brachial plexus block. BMC Anesthesiol 2018; 18: 107.
Albrecht E, Vorobeichik L, Jacot-Guillarmod A, Fournier N, Abdallah FW. Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block: Systematic Review and Indirect Meta-analysis. Anesth Analg 2019; 128: 543-554.
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet 2017; 56: 893-913.
Jones HG, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans MD, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Colorectal Dis 2018; 33: 857-862.
Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69(4): 1198-204.
Cruz FF, Rocco PRM, Pelosi P. Anti-inflammatory properties of anesthetics. J Phys Chem 2011; 27: 1097-1910.
Huang Y, Lu Y, Zhang L, Yan J, Jiang J, Jiang H. Perineural dexmedetomidine attenuates inflammation in rat sciatic nerve via the NF-κB pathway. Int J Mol Sci 2014; 15: 4049-4059.
Nie Y, Luo F, Wang L, Yang T, Shi L, Li X, Shen J, Xu W, Guo T, Lin Q. Anti-hyperlipidemic effect of rice bran polysaccharide and its potential mechanism in high-fat diet mice. Food Func 2017; 8(11): 4028-4041.
Ren Y, Jiao X, Zhang L. Expression level of fibroblast growth factor 5 (FGF5) in the peripheral blood of primary hypertension and its clinical significance. Saudi J Biol Sci 2018; 25(3): 469-473.
Bordbar M, Darvishzadeh R, Pazhouhandeh M, Kahrizi D. An overview of genome editing methods based on endonucleases. Modern Genetics J 2020; 15(2): 75-92.
Wang L, Lin Q, Yang T, Liang Y, Nie Y, Luo Y, Shen J, Fu X, Tang Y, Luo F. Oryzanol Modifies High Fat Diet-Induced Obesity, Liver Gene Expression Profile, and Inflammation Response in Mice. J Agri Food Chem 2017; 65(38): 8374-8385.
Zhang T, Wu X, Shaheen SM, Zhao Q, Liu X, Rinklebe J, Ren H. Ammonium nitrogen recovery from digestate by hydrothermal pretreatment followed by activated hydrochar sorption. Chem Eng J 2020; 379: 1-54.
Zhu B, Pang R, Chevallier J, Wei YM, Vo DT. Including intangible costs into the cost-of-illness approach: a method refinement illustrated based on the PM2.5 economic burden in China. Europ J Health Econ 2019; 20(4): 501-511.
Chen H, Chen Y, Yang L. Intelligent early structural health prognosis with nonlinear system identification for RFID signal analysis. Comput Commun 2020; 157: 150-161.
Yang M, Abdalrahman H, Sonia U, Mohammed A, Vestine U, Wang M, Ebadi AG, Toughani M. The application of DNA molecular markers in the study of Codonopsis species genetic variation, a review. Cell Mol Biol 2020; 2: 23-30.
He L, Fang H, Wang X, Wang Y, Ge H, Li C, Chen C, Wan Y, He H. The 100 most-cited articles in urological surgery: A bibliometric analysis. Int J Surg 2020; 75: 74-79
Chen HX, Huang L, Yang L, Chen YT, Huang JM. Model-based method with nonlinear ultrasonic system identification for mechanical structural health assessment. Trans Emerge Telecommun Technol 2020; 1-15.
Chen X, Xu Y, Meng L, Chen X, Yuan L, Cai Q, Shi W, Huang G. Non-parametric partial least squares-discriminant analysis model based on sum of ranking difference algorithm for tea grade identification using electronic tongue data. Sens Actuators B Chem 2020; 311:127924-127931.
Guo T, Lin Q, Li X, Nie Y, Wang L, Shi L, Xu W, Hu T, Guo T, Luo F. Octacosanol Attenuates Inflammation in Both RAW264.7 Macrophages and a Mouse Model of Colitis. J Agri Food Chem 2017; 65(18): 3647-3658.
Jiang X, Zhu B, Chevallier J, Xie R. Allocating provincial CO2 quotas for the Chinese national carbon program. Australian J Agri Res Econ 2018; 62(3): 457-479.
Li W, Jia MX, Wang JH, Lu JL, Deng J, Tang JX, Liu, C. Association of MMP9-1562C/T and MMP13-77A/G Polymorphisms with Non-Small Cell Lung Cancer in Southern Chinese Population. Biomolecules 2019; 9(3): 107-119.
Liang Y, Lin Q, Huang P, Wang Y, Li J, Zhang L, Cao J. Rice Bioactive Peptide Binding with TLR4 To Overcome H2O2-Induced Injury in Human Umbilical Vein Endothelial Cells through NF-kappa B Signaling. J Agri Food Chem 2018; 66(2): 440-448.
Lou Y, Guo D, Zhang H, Song L. Effectiveness of mesenchymal stems cells cultured by hanging drop vs. conventional culturing on the repair of hypoxic-ischemic-damaged mouse brains, measured by stemness gene expression. Open Life Sci 2016; 11(1): 519-523.
Lou Y, Shi J, Guo D, Qureshi AK, Song L. Function of PD-L1 in antitumor immunity of glioma cells. Saudi J Biol Sci 2017; 24(4): 803-807.
Lou Y, Yang J, Wang L, Chen X, Xin X, Liu Y. The clinical efficacy study of treatment to Chiari malformation type I with syringomyelia under the minimally invasive surgery of resection of Submeningeal cerebellar Tonsillar Herniation and reconstruction of Cisterna magna. Saudi J Biol Sci 2019; 26(8): 1927-1931.
Uslu M, Kaya E, Yaykasli KO, Oktay M, Inanmaz ME, Isık C, Erdem H, Erkan ME, Kandis H. Erythropoietin Stimulates Patellar Tendon Healing in Rats, Knee 2015; 22(6): 461-468.
Nie Y, Luo F, Lin Q. Dietary nutrition and gut microflora: A promising target for treating diseases. Trends Food Sci Technol 2018; 75: 72-80.