Dexmedetomidine as an adjuvant to levobupivacaine and lidocaine in ultrasound-guided superficial cervical block for carotid endarterectomy: a prospective, randomised, double- blinded study
Duration of sensory block and analgesia when using dexmedetomidine as an adjuvant to levobupivacaine and lidocaine in ultrasound-guided superficial cervical block for carotid endarterectomy: a prospective, randomised, double-blinded study
University hospital centre Sestre Milosrdnice
60 participants
Sep 28, 2021
Interventional
Conditions
Summary
Study hypothesis: Dexmedetomidine increases the duration of sensory block and analgesia when using it as an adjuvant to levobupivacaine and lidocaine in ultrasound-guided superficial cervical block for carotid endarterectomy surgery. 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.,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.
Eligibility
Inclusion Criteria1
- Patients with a critical stenosis (>70%) of the carotid artery. ASA I, II and III.
Exclusion Criteria1
- Patients older than 80 years, ASA > IV, severe liver dysfunction, body mass index >40, allergies to local anesthetics.
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Interventions
Superficial cervical block (SCB) was performed with 2 mg/kg 0.5% levobupivacaine, 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 anaesthetist who performes the procedure positioned the patient in supine position, with the head resting on pillow, looking to the opposite side. With the patient in the proper position, the skin was disinfected and the transducer is placed at the midpoint of the sternocleidomastoid muscle. The cervical plexus is identified, the needle is passed with in-plane approach behind the sternocleidomastoid muscle, the tip is placed adjacent to the plexus, and 15mL of local anesthetic mixture is administered. The rest of the local anesthetic mixture (35 mL) was injected subcutaneous cephalad and caudad along the length of the sternocleidomastoid muscle posterior border, and along the lower edge of the body of the mandible. The procedure was performed approximately 30 min prior to the initial surgical incision.
Locations(2)
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ACTRN12622000942752