1. Among patients undergoing shoulder arthroscopy, the use of dexmedetomidine as an adjuvant to an erector spinae plane block reduced intraoperative and postoperative opioid requirements.
Evidence Rating Level: 1 (Excellent)
Shoulder arthroscopy continues to be one of the most frequently performed orthopedic surgery. As postoperative pain is a significant consequence of this surgery, good pain management is key to optimal surgical results and recovery following surgery. Currently, several analgesic strategies such as regional nerve blocks, local anesthetic, non-steroidal anti-inflammatory drugs, intravenous opioids, and patient-controlled analgesia are commonly used modalities. The erector spinae plane block (ESPB) is a novel anesthetic technique that can manage acute pain. Dexmedetomidine is an effective alpha-2 agonist which lowers blood pressure and can improve anesthesia produced by other analgesics. This study aimed to investigate whether the use of dexmedetomidine as an adjuvant to ESPB can improve pain outcomes in patients with acute postoperative pain following shoulder arthroscopy. Participants between the ages of 18 to 65 years scheduled for an elective shoulder arthroscopy were randomly assigned to two groups; the control group received only ESPB and the intervention group received both ESPB and DEX. The primary outcome assessed in this study was total post-operative morphine consumption. The results of this study showed that the mean intraoperative fentanyl consumption was significantly lower in the intervention group compared to the control group. Additionally, the median total postoperative morphine consumption within 24 hours following surgery was significantly lower in the intervention group compared to the control group. This paper concludes the efficacy of dexmedetomidine as an adjuvant to ESBP in producing adequate analgesia in the context of shoulder arthroscopy. Future research investigating the utility of dexmedetomidine as an adjuvant for other analgesic modalities and its use during various types of surgeries may be beneficial.
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