Discussion
dislocation, pain, catheter infection, brachial plexus block, hemidiaphragmatic paresis
CATHETER INFECTION
In this prospective, randomized, controlled study, we found that the addition of dexmedetomidine to ropivacaine for IBPB significantly prolonged the duration of postoperative analgesia, prolonged the first time of PCA pressed, reduced the consumption of sufentanil and improved the patient’s satisfaction in patients undergoing arthroscopic shoulder surgery.The interscalene brachial plexus block is a commonly used regional anesthesia technique, it has been considered as the standard treatment for pain management after shoulder surgery. Ultrasound technology has aided anesthetists in depositing local anesthetics in precise proximity to targeted peripheral nerves, so there is no need to use a large volume of local anesthetics for IBPB. Meanwhile, Studies have demonstrated that local anesthetic volumes of 20 ml or more may associate with a high incidence of hemidiaphragmatic paresis after interscalene brachial plexus block, although it can be resolved by decreasing local anesthetic volume to 5 to 10 ml, this may result in a clinically significant reduction in the duration and potency of perioperative analgesia and may also lead to a high risk of block failure[The relatively short duration of analgesia is a major limitation of single-shot IBPB. While the catheter-based technique provides sustained pain management during the perioperative period, this technique can present challenges related to patient management, catheter dislocation, and the potential for increased catheter infection risk[Dexmedetomidine, a highly selective α2 adrenoreceptor agonist, is currently the most widely used additive drug in regional anesthesia. Previous studies have shown that dexmedetomidine can effectively prolong the IBPB analgesic duration and reduce opioid consumption without prolonging motor blockade when administrated intravenously[In our study, the results showed that compared with 0.25% ropivacaine alone, adding 0.5 μg/kg dexmedetomidine to 0.25% ropivacaine for IBPB prolonged the duration of analgesia approximately 3.5 h on average (8.25 Multiple basic science studies have demonstrated the effects of perineural dexmedetomidine to be peripheral and not due to systemic analgesia or other αPatient-controlled analgesia (PCA) is one of the well-established methods for providing postoperative analgesia, a key component for implementing multimodal analgesia. In our study, we used PCA and IBPB as the postoperative analgesic method for arthroscopic shoulder surgery. In fact, no patient required rescue analgesic, which demonstrated our analgesia strategy was successful. Meanwhile, our results showed that dexmedetomidine added to ropivacaine for IBPB prolonged the first time of PCA pressed, decreased the frequencies of PCA pressed at 4–8 and 8–12 h time intervals, reduced the total 24h sufentanil consumption, and improved the patient’s satisfaction. Our results were consistent with a previous study conducted by Yang et al., which concluded that the transversus abdominis plane block reduced morphine consumption in the first 24 h following renal transplantation, and the addition of dexmedetomidine provided a more effective analgesic effect [