Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial.

BACKGROUND: Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model. METHODS: Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 µg/kg loading, .2-.5 µg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values. RESULTS: In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (P < .0001) in the anesthetic recovery room. CONCLUSIONS: Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.

Outcomes of dexmedetomidine as adjuvant drug in patients undergoing videolaparoscopic cholecystectomy: A randomized and prospective clinical trial.

OBJECTIVE: The repercussions of ischemia-reperfusion and inflammatory response to surgical injury may compromise the return of physiologic processes in video-laparoscopic surgeries. Dexmedetomidine, as an adjuvant drug in general anesthesia, alters the neuroinflammatory reaction, provides better clinical outcomes in the perioperative period, and may reduce the excessive use of chronic medication in patients with a history of addiction. This study evaluated the immunomodulatory potential of dexmedetomidine on perioperative organ function in video-laparoscopic cholecystectomy patients. METHODS: There were two groups: Sevoflurane and Dexmedetomidine A (26 patients) vs. Sevoflurane and Saline 0.9% B (26 patients). Three blood samples were collected three times: 1) before surgery, 2) 4-6h after surgery, and 3) 24h postoperatively. Inflammatory and endocrine mediators were protocolized for analysis. Finally, hemodynamic outcomes, quality upon awakening, pain, postoperative nausea and vomiting, and opioid use were compared between groups. RESULTS: We have demonstrated a reduction of Interleukin 6 six hours after surgery in group A: 34.10 (IQR 13.88-56.15) vs. 65.79 (IQR 23.13-104.97; p = 0.0425) in group B. Systolic blood pressure, diastolic blood pressure, and mean arterial pressure was attenuated in group A in their measurement intervals (p < 0.0001). There was a lower incidence of pain and opioid consumption in the first postoperative hour favoring this group (p < 0.0001). We noticed better quality upon awakening after the intervention when comparing the values of peripheral oxygen saturation and respiratory rate. CONCLUSIONS: Dexmedetomidine provided anti-inflammatory benefits and contributed to postoperative analgesia without the depressive side effects on the respiratory and cardiovascular systems commonly observed with opioids. TRIAL REGISTRATION: Immunomodulatory Effect of Dexmedetomidine as an Adjuvant Drug in Laparoscopic Cholecystectomies, NCT05489900, Registered 5 August 2022-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05489900?term=NCT05489900&draw=2&rank=1.

Effect of Quadratus Lumborum Block on Pain and Stress Response after Video Laparoscopic Surgeries: A Randomized Clinical Trial.

BACKGROUND: There are many surgical and anesthetic factors that affect pain and the endocrine-metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. OBJECTIVE: To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma. METHODS: We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol. RESULTS: Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores. CONCLUSION: Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.

Effects of Dexmedetomidine on Immunomodulation and Pain Control in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial.

AIM: Digital and robotic technology applications in laparoscopic surgery have revolutionized routine cholecystectomy. Insufflation of the peritoneal space is vital for its safety but comes at the cost of ischemia-reperfusion-induced intraabdominal organ compromise before the return of physiologic functions. Dexmedetomidine in general anesthesia promotes controlling the response to trauma by altering the neuroinflammatory reflex. This strategy may improve clinical outcomes in the postoperative period by reducing postoperative narcotic use and lowering the risk of subsequent addiction. In this study, the authors aimed to evaluate dexmedetomidine's therapeutic and immunomodulatory potential on perioperative organ function. METHODS: Fifty-two patients were randomized 1:1: group A-sevoflurane and dexmedetomidine (dexmedetomidine infusion [1 µg/kg loading, 0.2-0.5 µg/kg/h maintenance dose]), and group B-sevoflurane with saline 0.9% infusion as a placebo control. Three blood samples were collected: preoperatively (T0 h), 4-6 h after surgery (T4-6 h), and 24 h postoperatively (T24 h). The primary outcome was the level analysis of inflammatory and endocrine mediators. Secondary outcome measures were the time to return to normal preoperative hemodynamic parameters, spontaneous ventilation, and postoperative narcotic requirements to control surgical pain. RESULTS: A reduction of Interleukin 6 was found at 4-6 h after surgery in group A with a mean of 54.76 (27.15-82.37; CI 95%) vs. 97.43 (53.63-141.22); p = 0.0425) in group B patients. Systolic and diastolic blood pressure and heart rate were lower in group A patients, who also had a statistically significantly lower opioid consumption in the first postoperative hour when compared to group B patients (p < 0.0001). We noticed a similar return to spontaneous ventilation pattern in both groups. CONCLUSIONS: Dexmedetomidine decreased interleukin-6 4-6 h after surgery, likely by providing a sympatholytic effect. It provides good perioperative analgesia without respiratory depression. Implementing dexmedetomidine during laparoscopic cholecystectomy has a good safety profile and may lower healthcare expenditure due to faster postoperative recovery.

Outcome of Ultrasound Guided Anterior Quadratus Lumborum Block After Video Laparoscopic Cholecystectomies: A Prospective Randomized Clinical Trial.

BACKGROUND: Laparoscopy revolutionizing digital and robotic technology for surgical practice. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. OBJECTIVES: evaluate if Anterior Quadratus Lumborum Block contributes to attenuate surgical repercussions, having as primary parameters analgesia and secondary the pulmonary function and neuroendocrine response to trauma. METHODS: prospective, controlled, Double-blind study, in which 51 patients scheduled for eletive laparoscopic cholecystectomy were randomly selected and distributed into 2 groups. Control group received general anesthesia, and the intervention group was submitted to general anesthesia plus Anterior Quadratus Lumborum Block. The parameters evaluated were: postoperative pain, respiratory muscle pressure, and inflammatory response to surgical stress with the plasma dosage of Interleukin 6, C-Reactive protein and cortisol. The following situations were excluded: refusal to participate in the study; body mass index greater than or equal to 40, peripheral neuropathies, coagulopathies or hypersensitivity to drugs used; infection at the puncture site; fever, purities; dementia or other states that would prevent the adequate understanding of the use of the numeric-verbal scale of pain; immunological diseases, diabetes, malignant neoplasia, use of opioids or anti-inflammatory drugs in the preoperative period; antidepressants and anticonvulsants, conversion open surgery, re-exploration and hospital stay. RESULTS: Slowed Interleukin 6 cytokine production and decrease in cortisol release, accompanied by significant attenuation of surgical repercussion on lung function and significant reduction in postoperative pain scores and consumption of pain medication. CONCLUSION: An important strategy for analgesia in abdominal laparoscopic surgery.

Análise comparativa entre duas técnicas de analgesia no pós-operatório de cirurgias artroscópicas de ombro: bloqueio interescalênico e bloqueios dos nervos supraescapular e axilar / Comparative analysis between two analgesic techniques Arthroscopic shoulder surgeries: Interstellar blockage and blockages of the suprascapular and axillary nerves

Com o advento das cirurgias artroscópicas, a abordagem da articulação do ombro passou a ser menos invasiva do que nos procedimentos convencionais. Apesar da redução da dor nos primeiros dias após o procedimento ser atribuída à técnica artroscópica, uma parcela significativa de pacientes relata dor de forte intensidade nas primeiras 24 a 48 horas de pósoperatório. A anestesia regional oferece alta qualidade de analgesia intra e pós-operatória. O bloqueio interescalênico é o padrão ouro para analgesia pós-operatória em cirurgias do ombro. O bloqueio seletivo dos nervos supraescapular e axilar surgiu como uma alternativa segura ao bloqueio interescalênico, mostrando alta eficácia. O objetivo do presente estudo foi comparar a qualidade da analgesia oferecida por duas técnicas de anestesia regional ­ bloqueio interescalênico e o bloqueio seletivo dos nervos supra-escapular e axilar - para a analgesia pós-operatória em pacientes submetidos a cirurgia artroscópica de ombro para reparo de lesão do manguito rotador. Constituiu a amostra do estudo quarenta e sete pacientes com lesão do manguito rotador, tratados no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Foram utilizados como parâmetros de comparação, o tempo necessário para a realização dos dois tipos de bloqueios, a necessidade de opioides para analgesia suplementar no pós-operatório, a ocorrência de complicações sistêmicas, a intensidade da dor, e sua possível relação com a duração da cirurgia. Todos os pacientes foram avaliados após 2h e 12h no pós-operatório. Os resultados mostraram eficácia e segurança das duas técnicas, sendo o tempo para a realização dos bloqueios seletivos maior. O bloqueio interescalênico oferece melhor qualidade de analgesia nas primeiras horas de pós-operatório em relação à técnica seletiva e com 12 horas a analgesia proporcionada pelos dois bloqueios é equivalente. O desconforto resultante da paralisia motora é prevalente e mais prolongado no bloqueio interescalênico e a necessidade de analgesia suplementar com opioide é maior no bloqueio seletivo apenas nas primeiras horas do pós-operatório e com 12 horas a demanda foi semelhante nos dois grupos. Não houve relação entre duração da cirurgia e dor pósoperatória. O conjunto dos nossos resultados demonstrou que as duas técnicas de analgesia que foram avaliadas mostraram-se seguras em pacientes isentos de comorbidades pulmonares. A técnica interescalênica tem como vantagem oferecer analgesia de melhor qualidade na primeiras horas do pós-operatório e ser realizada através de um único procedimento. Por outro lado tem duração mais curta e pode se associar a alguns efeitos adversos como paresia hemidiafragmática e hiperalgesia pós-bloqueio. Os bloqueios seletivos tem duração mais prolongada e se associam a eventos que podem ocorrer nos bloqueios regionais em geral. Como principal desvantagem do bloqueio seletivo, ressaltamos a necessidade da realização de dois procedimentos independentes, não oferecer anestesia do ombro em sua totalidade e a necessidade do treinamento específico por não ser uma técnica utilizada na rotina dos especialistas. Diante das vantagens e desvantagens, consideramos que cabe ao anestesiologista em decisão conjunta com o cirurgião, a escolha da técnica mais indicada para cada tipo de paciente, considerando a presença de comorbidades, a gravidade da lesão, o tempo de evolução clínica e o tipo de procedimento cirúrgico que está sendo proposto

With the advent of arthroscopic surgery, the approach of the shoulder joint has become less invasive than conventional procedures. Despite the reduction in pain in the first days after the procedure be attributed to arthroscopy, a significant number of patients report severe pain in the first 24 to 48 hours postoperatively. Regional anesthesia offers high quality intraoperative and postoperative analgesia. The interscalene block is the gold standard for postoperative analgesia for shoulder surgeries. Selective blocking of suprascapular and axillary nerves emerged as a safe alternative to interscalene block, with high rates of efficacy. The aim of this study was to compare the quality of analgesia offered by two regional anesthesia techniques - interescalenic block and selective block of suprascapular and axillary nerves - for postoperative analgesia in patients undergoing shoulder arthroscopic surgery to repair rotator cuff injury. The sample of the study comprised forty-seven patients with rotator cuff injury treated at the National Institute of Traumatology Jamil Haddad. It was used as comparison parameter, the time required to perform the two types of blocks, the amount of opioid needed as additional analgesia postoperatively, the occurrence of systemic complications, pain intensity, and its relation to surgery duration. All patients were evaluated after 2 h and 12 h postoperatively. The results showed efficacy and safety of the two techniques; however the time to perform the selective blocks was greater. The interscalene block provides better analgesia in the early hours after surgery compared to the selective technique and analgesia provided by the two blocks after 12 hours was equivalent. The discomfort resulting of motor paralysis was prevalent and longer in the interscalene block. The need for additional analgesia with opioids was higher in selective blocks only in the first hours of the postoperative period with similar demand in both groups after 12 hours. There was no relationship between duration of surgery and postoperative pain. Taken together, our results demonstrated that both analgesia techniques that were evaluated were safe for patients without pulmonary comorbidities. The interscalene technique has the advantage of offering better quality of analgesia in the first hours of the postoperative period and to be carried out through a single procedure. On the other hand it has a shorter duration and may be associated with some adverse effects such as hemidiaphragmatic paresis and post-block hyperalgesia. The selective block lasts longer and is associated with events that may occur in regional blocks in general. As a main disadvantage of the selective block, we emphasize the need to carry out two independent procedures, do not offer shoulder anesthesia in its integrity and the need for specific training considering that is not used routinely. Taking into account the advantages and disadvantages of both techniques, we believe that it is up to the anesthesiologist, in a joint decision with the surgeon, to decide the technique more appropriate for each type of patient considering the presence of comorbidities, severity of the injury, the duration of clinical symptoms and the type of surgical procedure that is being proposed