Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial
Background: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/12/2579 |
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| author | Chahyun Oh Boohwi Hong Yumin Jo Seungbin Jeon Sooyong Park Woosuk Chung Youngkwon Ko Sun Yeul Lee Chaeseong Lim |
| author_facet | Chahyun Oh Boohwi Hong Yumin Jo Seungbin Jeon Sooyong Park Woosuk Chung Youngkwon Ko Sun Yeul Lee Chaeseong Lim |
| author_sort | Chahyun Oh |
| collection | DOAJ |
| description | Background: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during dexmedetomidine infusion. Methods: Patients scheduled for upper extremity surgery were randomly allocated into a control and an epinephrine group. All patients received brachial plexus blockade, consisting of 25 mL of a 1:1 mixture of 1% lidocaine and 0.75% ropivacaine, with patients in the epinephrine group also receiving 125 μg epinephrine. Intraoperative sedation was induced using dexmedetomidine at a loading dose of 1 µg/kg and maintenance dose of 0.4 µg/kg/hr. The primary outcome was the incidence of intraoperative hypotension or hypotension in the post-anesthesia care unit (PACU). Results: One hundred and thirty patients were included (65 per group). The incidence of hypotension was significantly higher in the epinephrine than in the control group (80.6% vs. 56.9%, <i>p</i> = 0.009). The duration of hypotension and the maximal change in blood pressure were also greater in the epinephrine group. Conclusions: Perineural epinephrine for brachial plexus blockade does not reduce hypotension due to dexmedetomidine infusion and may actually augment the occurrence of hypotensive events. |
| first_indexed | 2024-03-10T10:30:00Z |
| format | Article |
| id | doaj.art-1aed66efc32445a69063c447dab68c46 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T10:30:00Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1aed66efc32445a69063c447dab68c462023-11-21T23:42:24ZengMDPI AGJournal of Clinical Medicine2077-03832021-06-011012257910.3390/jcm10122579Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled TrialChahyun Oh0Boohwi Hong1Yumin Jo2Seungbin Jeon3Sooyong Park4Woosuk Chung5Youngkwon Ko6Sun Yeul Lee7Chaeseong Lim8Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaDepartment of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, KoreaBackground: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during dexmedetomidine infusion. Methods: Patients scheduled for upper extremity surgery were randomly allocated into a control and an epinephrine group. All patients received brachial plexus blockade, consisting of 25 mL of a 1:1 mixture of 1% lidocaine and 0.75% ropivacaine, with patients in the epinephrine group also receiving 125 μg epinephrine. Intraoperative sedation was induced using dexmedetomidine at a loading dose of 1 µg/kg and maintenance dose of 0.4 µg/kg/hr. The primary outcome was the incidence of intraoperative hypotension or hypotension in the post-anesthesia care unit (PACU). Results: One hundred and thirty patients were included (65 per group). The incidence of hypotension was significantly higher in the epinephrine than in the control group (80.6% vs. 56.9%, <i>p</i> = 0.009). The duration of hypotension and the maximal change in blood pressure were also greater in the epinephrine group. Conclusions: Perineural epinephrine for brachial plexus blockade does not reduce hypotension due to dexmedetomidine infusion and may actually augment the occurrence of hypotensive events.https://www.mdpi.com/2077-0383/10/12/2579epinephrinedexmedetomidineregional anesthesiabrachial plexus blocksedationhypotension |
| spellingShingle | Chahyun Oh Boohwi Hong Yumin Jo Seungbin Jeon Sooyong Park Woosuk Chung Youngkwon Ko Sun Yeul Lee Chaeseong Lim Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial Journal of Clinical Medicine epinephrine dexmedetomidine regional anesthesia brachial plexus block sedation hypotension |
| title | Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial |
| title_full | Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial |
| title_fullStr | Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial |
| title_full_unstemmed | Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial |
| title_short | Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial |
| title_sort | perineural epinephrine for brachial plexus block increases the incidence of hypotension during dexmedetomidine infusion a single center randomized controlled trial |
| topic | epinephrine dexmedetomidine regional anesthesia brachial plexus block sedation hypotension |
| url | https://www.mdpi.com/2077-0383/10/12/2579 |
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