Marhofer P, Brummett CM. Safety and efficiency of dexmedetomidine as adjuvant to local anesthetics. Curr Opin Anaesthesiol 2016;29:632–637.
Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 2013;110:915–925.
Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2017;118:167–181.
Brummett CM, Norat MA, Palmisano JM, et al. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology 2008;109:502–511.
Akhondzadeh R, Rashidi M, Gousheh M, et al. The effect of adding dexmedetomidine as an adjuvant to lidocaine in forearm fracture surgeries by supraclavicular block procedure under ultrasound-guided. Anesth Pain Med 2018;8:e74355.
Fritsch G, Danninger T, Allerberger K, et al. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med 2014;39:37–47.
Keplinger M, Marhofer P, Kettner SC, et al. A pharmacodynamic evaluation of dexmedetomidine as an additive drug to ropivacaine for peripheral nerve blockade: a randomised, triple-blind, controlled study in volunteers. Eur J Anaesthesiol 2015;32:790–796.
Bisui B, Samanta S, Ghoshmaulik S, et al. Effect of locally administered dexmedetomidine as adjuvant to levobupivacaine in supraclavicular brachial plexus block: double-blind controlled study. Anesth Essays Res 2017;11:981–986.
Jung HS, Seo KH, Kang JH, et al. Optimal dose of perineural dexmedetomidine for interscalene brachial plexus block to control postoperative pain in patients undergoing arthroscopic shoulder surgery: a prospective, double-blind, randomized controlled study. Medicine (Baltimore) 2018;97:e0440.
Abdallah FW, Dwyer T, Chan VW, et al. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triple-masked, placebo-controlled trial. Anesthesiology 2016;124:683–695.
Bartel AK, Campoy L, Martin-Flores M, et al. Comparison of bupivacaine and dexmedetomidine femoral and sciatic nerve blocks with bupivacaine and buprenorphine epidural injection for stifle arthroplasty in dogs. Vet Anaesth Analg 2016;43:435–443.
Trein TA, Floriano BP, Wagatsuma JT, et al. Effects of dexmedetomidine combined with ropivacaine on sciatic and femoral nerve blockade in dogs. Vet Anaesth Analg 2017;44:144–153.
Campoy L, Bezuidenhout AJ, Gleed RD, et al. Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs. Vet Anaesth Analg 2010;37:144–153.
Hofmeister EH, Chandler MJ, Read MR. Effects of acepromazine, hydromorphone, or an acepromazine-hydromorphone combination on the degree of sedation in clinically normal dogs (Erratum published in J Am Vet Med Assoc 2011;238:182). J Am Vet Med Assoc 2010;237:1155–1159.
Szerkus O, Struck-Lewicka W, Kordalewska M, et al. HPLC-MS/MS method for dexmedetomidine quantification with design of experiments approach: application to pediatric pharmacokinetic study. Bioanalysis 2017;9:395–406.
US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Veterinary Medicine. Guidance for industry: bioanalytical method validation. Available at: academy.gmp-compliance.org/guidemgr/files/4252FNL.PDF. Accessed Aug 9, 2020.
Kirksey MA, Haskins SC, Cheng J, et al. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One 2015;10:e0137312.
Lin YN, Li Q, Yang RM, et al. Addition of dexmedetomidine to ropivacaine improves cervical plexus block. Acta Anaesthesiol Taiwan 2013;51:63–66.
Rancourt MP, Albert NT, Côté M, et al.. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesth Analg 2012;115:958–962.
Bloor BC, Ward DS, Belleville JP, et al. Effects of intravenous dexmedetomidine in humans. II Hemodynamic changes. Anesthesiology 1992;77:1134–1142.
Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000;93:382–394.
Andersen JH, Grevstad U, Siegel H, et al. Does dexmedetomidine have a perineural mechanism of action when used as an adjuvant to ropivacaine?: a paired, blinded, randomized trial in healthy volunteers. Anesthesiology 2017;126:66–73.
Yoshitomi T, Kohjitani A, Maeda S, et al. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg 2008;107:96–101.
Kosugi T, Mizuta K, Fujita T, et al. High concentrations of dexmedetomidine inhibit compound action potentials in frog sciatic nerves without alpha(2) adrenoceptor activation. Br J Pharmacol 2010;160:1662–1676.
Brummett CM, Hong EK, Janda AM, et al. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current. Anesthesiology 2011;115:836–843.
Advertisement
To evaluate the effects of using ropivacaine combined with dexmedetomidine for sciatic and saphenous nerve blocks in dogs.
7 healthy adult Beagles.
In phase 1, dogs received each of the following 3 treatments in random order: perineural sciatic and saphenous nerve injections of 0.5% ropivacaine (0.4 mL/kg) mixed with saline (0.9% NaCl) solution (0.04 mL/kg; DEX0PN), 0.5% ropivacaine mixed with dexmedetomidine (1 µg/kg; DEX1PN), and 0.5% ropivacaine mixed with dexmedetomidine (2 µg/kg; DEX2PN). In phase 2, dogs received perineural sciatic and saphenous nerve injections of 0.5% ropivacaine and an IV injection of diluted dexmedetomidine (1 µg/kg; DEX1IV). For perineural injections, the dose was divided equally between the 2 sites. Duration of sensory blockade was evaluated, and plasma dexmedetomidine concentrations were measured.
Duration of sensory blockade was significantly longer with DEX1PN and DEX2PN, compared with DEX0PN; DEX1IV did not prolong duration of sensory blockade, compared with DEX0PN. Peak plasma dexmedetomidine concentrations were reached after 15 minutes with DEX1PN (mean ± SD, 348 ± 200 pg/mL) and after 30 minutes DEX2PN (816 ± 607 pg/mL), and bioavailability was 54 ± 40% and 73 ± 43%, respectively. The highest plasma dexmedetomidine concentration was measured with DEX1IV (1,032 ± 415 pg/mL) 5 minutes after injection.
Results suggested that perineural injection of 0.5% ropivacaine in combination with dexmedetomidine (1 µg/kg) for locoregional anesthesia in dogs seemed to balance the benefit of prolonging sensory nerve blockade while minimizing adverse effects.