Clinical neurology and neurosurgery · 2025
Comparison of the efficacy of dexmedetomidine and dexamethasone as adjuvants to ropivacaine for scalp nerve block in patients undergoing awake craniotomy: A randomized controlled trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sharma Leena, Reddy Ashwini, Chauhan Rajeev, Panda Nidhi, Luthra Ankur, Meena Shyam Charan, Sarna Rashi, Sahoo Sushant Kumar
Аннотация
BACKGROUND: Dexmedetomidine, an alpha-2 adrenoceptor agonist, and dexamethasone are known to prolong analgesia when used as adjuvants in peripheral nerve blocks. However, their comparative efficacy as perineural adjuvants in scalp nerve blocks (SNB) for awake craniotomy remains uncertain.
METHODS: Fifty adults degree of postoperative sedation (18-65 years) undergoing awake craniotomy were randomized to receive SNB with 30 ml of 0.5 % ropivacaine plus dexmedetomidine 1 μg/kg (Group D, n = 25) or dexamethasone 8 mg (Group Z, n = 25), 20 min before skull pin fixation. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative pain (numerical rating scale, NRS), 24-hour rescue analgesic consumption, onset of sensory block, perioperative hemodynamics during application of noxious stimulus, degree postoperative sedation, and incidence of any complications.
RESULTS: The time to first rescue analgesia was significantly longer in Group D than in Group Z (14 [12-16] vs. 12.3 [9-13] h, P = 0.03). Rescue analgesic consumption was lower in Group D (1.64 ± 0.82 vs. 2.26 ± 0.89, P = 0.021). Pain scores were significantly reduced in Group D at 8 h (P = 0.01) and 12 h (P = 0.01). Group D also showed lower heart rate at skull pin fixation (P = 0.02), skin incision (P = 0.03), and closure (P = 0.001), and lower mean arterial pressure at dural (P = 0.001) and skin closure (P = 0.007). The onset of sensory block, sedation scores, and complications were comparable.
CONCLUSION: Perineural dexmedetomidine as an adjuvant to ropivacaine in SNB prolongs postoperative analgesia, reduces rescue analgesic requirements, and provides superior attenuation of the hemodynamic response to noxious stimulus as compared to dexamethasone, in the absence of any adverse effects. Clinical Trials Registry-India (CTRI) ID: CTRI/2024/01/062046.
METHODS: Fifty adults degree of postoperative sedation (18-65 years) undergoing awake craniotomy were randomized to receive SNB with 30 ml of 0.5 % ropivacaine plus dexmedetomidine 1 μg/kg (Group D, n = 25) or dexamethasone 8 mg (Group Z, n = 25), 20 min before skull pin fixation. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative pain (numerical rating scale, NRS), 24-hour rescue analgesic consumption, onset of sensory block, perioperative hemodynamics during application of noxious stimulus, degree postoperative sedation, and incidence of any complications.
RESULTS: The time to first rescue analgesia was significantly longer in Group D than in Group Z (14 [12-16] vs. 12.3 [9-13] h, P = 0.03). Rescue analgesic consumption was lower in Group D (1.64 ± 0.82 vs. 2.26 ± 0.89, P = 0.021). Pain scores were significantly reduced in Group D at 8 h (P = 0.01) and 12 h (P = 0.01). Group D also showed lower heart rate at skull pin fixation (P = 0.02), skin incision (P = 0.03), and closure (P = 0.001), and lower mean arterial pressure at dural (P = 0.001) and skin closure (P = 0.007). The onset of sensory block, sedation scores, and complications were comparable.
CONCLUSION: Perineural dexmedetomidine as an adjuvant to ropivacaine in SNB prolongs postoperative analgesia, reduces rescue analgesic requirements, and provides superior attenuation of the hemodynamic response to noxious stimulus as compared to dexamethasone, in the absence of any adverse effects. Clinical Trials Registry-India (CTRI) ID: CTRI/2024/01/062046.