Dexmedetomidine is a viable option for upper-limb blocks in patients undergoing surgery, according to a study presented here at the 2017 Annual Meeting of the Canadian Anesthesiologists Society (CAS).
“The use of dexmedetomidine will make the block last longer [compared to propofol],” said Angela Builes, MD, Western University/London Health Sciences Center, London, Ontario, on June 25. “In regional anaesthesia, we are looking at using new agents that will make our blocks have a longer effect.”
Dexmedetomidine differs from propofol in that it can provide sedation without producing a risk of respiratory depression. More steps are involved in preparing dexmedetomidine versus propofol for anaesthetic use.
Investigators included patients aged 18 to 80 years who had a body mass index of ≤35 kg/m2. Patients with significant preexisting major organ dysfunction, psychiatric illness, or significant cardiac or respiratory disease, among other conditions, were not included in the study.
The researchers randomised patients who were undergoing upper-limb surgery to propofol (n = 49) or dexmedetomidine (n = 49).
Of the total number of patients, 10 converted to general anaesthesia because the infraclavicular block was not completely effective or the patient was uncomfortable and could not lie still during the procedure. Complete follow-up was available for 86 patients, 40 of whom received dexmedetomidine and 46 of whom received propofol.
No statistically significant difference was found in duration of the sensory block, with the dexmedetomidine lasting 13.8 hours and the propofol lasting 12 hours. However, Dr. Builes noted that despite a lack of statistical significance, 110 minutes represents clinical significance for patients.
“If you can prolong the block as much as possible, the patient can have a good night’s sleep and not be in pain,” said Dr. Builes.
“You can use dexmedetomidine as an alternative for sedation for patients who are having a block for the upper limb. It is noninferior to propofol,” he concluded.
No difference in opioid use was seen between the 2 arms of the study.