Assessment of the effect of perineural dexmedetomidine on oxidative stress during peritoneal dialysis catheter insertion: a randomized, controlled trial

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Abstract

Purpose

This study aimed to evaluate the effect of the addition of dexmedetomidine to ropivacaine on oxidative stress during transversus abdominis plane (TAP) and rectus sheath (RS) blockades for patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) catheter insertion.

Methods

Sixty patients with ESRD undergoing PD catheter insertion to receive left ultrasound-guided TAP and RS blockades were randomly divided into two groups: the dexmedetomidine plus ropivacaine group (25 mL of 0.3% ropivacaine + 1 μg/kg dexmedetomidine) and the ropivacaine group (25 mL of 0.3% ropivacaine). Primary outcomes were oxidative stress marker levels during the procedure.

Results

A total of 60 patients (30 patients in each group) were evaluated. Compared with the ropivacaine group, the dexmedetomidine plus ropivacaine group had significantly lower serum malondialdehyde levels ( P < 0.05) and increased glutathione peroxidase ( P < 0.01) and superoxide dismutase levels at 24 h after the procedure ( P < 0.01).

Conclusion

The addition of 1 μg/kg of dexmedetomidine to ropivacaine for ultrasound-guided TAP and RS blockades could inhibit oxidative stress in patients with ESRD undergoing PD catheter insertion.

Trial registration This study was registered at www.chictr.org.cn on June 7, 2021 (ChiCTR2100047050).

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Most cited references 34

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The stress response to trauma and surgery

J.P. DESBOROUGH (2000)

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Oxidative stress is progressively enhanced with advancing stages of CKD.

Kostas Siamopoulos, Areti Makedou, Evangelia Dounousi … (2006)

Oxidative stress appears to have a central role in the pathophysiological process of uremia and its complications, including cardiovascular disease. However, there is little evidence to suggest how early oxidative stress starts developing during the progression of chronic kidney disease (CKD). The aim of this study is to assess oxidative stress activity in a cross-sectional study of patients with CKD stages 1 to 4. Eighty-seven steady patients (47 men, 40 women) with a median age of 62 years (range, 28 to 84 years) and mean estimated glomerular filtration rate (eGFR) of 57 mL/min (0.95 mL/s) were studied. Levels of plasma 8-isoprostanes (8-epiPGF2a) and serum total antioxidant status (TAS) were used as markers of oxidative stress. 8-epiPGF2a levels were determined by using an enzyme-linked immunosorbent assay method, whereas a chromatometric method was used to determine TAS. Plasma 8-epiPGF2a levels increased significantly as CKD stages advanced (P < 0.001). There was a highly significant inverse correlation between 8-epiPGF2a level and GFR (P < 0.01). Serum TAS levels also increased in a similar fashion (P < 0.009) and showed a significant inverse correlation with GFR (P < 0.01). 8-epiPGF2a and TAS levels showed a positive correlation (P < 0.05). Multiple regression analysis showed that the most significant predictor variable for 8-epiPGF2a level was eGFR, whereas the association between eGFR and TAS was affected strongly by confounding variables, mainly uric acid level. Oxidative stress appears to increase as CKD progresses and correlates significantly with level of renal function. Increased TAS seems to be dependent on several confounding variables, including increased uric acid levels, and therefore does not seem to be a reliable method for assessing the antioxidant capacity of patients with CKD. These results suggest that larger studies using the correct markers to assess the timing and complex interplay of oxidative stress and other risk factors during the progression of CKD should be carried out.

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Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current.

William Janda, Francesco Amodeo, Mun Hong … (2011)

The current study was designed to test the hypothesis that the increased duration of analgesia caused by adding dexmedetomidine to local anesthetic results from blockade of the hyperpolarization-activated cation (I(h)) current. In this randomized, blinded, controlled study, the analgesic effects of peripheral nerve blocks using 0.5% ropivacaine alone or 0.5% ropivacaine plus dexmedetomidine (34 μM or 6 μg/kg) were assessed with or without the pretreatment of α(1)- and α(2)-adrenoceptor antagonists (prazosin and idazoxan, respectively) and antagonists and agonists of the I(h) current (ZD 7288 and forskolin, respectively). Sciatic nerve blocks were performed, and analgesia was measured by paw withdrawal latency to a thermal stimulus every 30 min for 300 min postblock. The analgesic effect of dexmedetomidine added to ropivacaine was not reversed by either prazosin or idazoxan. There were no additive or attenuated effects from the pretreatment with ZD 7288 (I(h) current blocker) compared with dexmedetomidine added to ropivacaine. When forskolin was administered as a pretreatment to ropivacaine plus dexmedetomidine, there were statistically significant reductions in duration of analgesia at time points 90-180 min (P < 0.0001 for each individual comparison). The duration of blockade for the forskolin (768 μM) followed by ropivacaine plus dexmedetomidine group mirrored the pattern of the ropivacaine alone group, thereby implying a reversal effect. Dexmedetomidine added to ropivacaine caused approximately a 75% increase in the duration of analgesia, which was reversed by pretreatment with an I(h) current enhancer. The analgesic effect of dexmedetomidine was not reversed by an α(2)-adrenoceptor antagonist.

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Author and article information

Contributors

Reai Shan: shanreai@163.com

Journal

Journal ID (nlm-ta): Int Urol Nephrol

Journal ID (iso-abbrev): Int Urol Nephrol

Title: International Urology and Nephrology

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 0301-1623

ISSN (Electronic): 1573-2584

Publication date (Electronic): 30 June 2022

Publication date PMC-release: 30 June 2022

Publication date (Print): 2022

Volume: 54

Issue: 12

Pages: 3203-3210

Affiliations

[1 ]GRID grid.440714.2, ISNI 0000 0004 1797 9454, First Clinical Medical College, , Gannan Medical University, ; Ganzhou, China

[2 ]GRID grid.440714.2, ISNI 0000 0004 1797 9454, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, , Gannan Medical University, ; Ganzhou, China

[3 ]GRID grid.452437.3, Department of Nephrology, , First Affiliated Hospital of Gannan Medical University, ; Ganzhou, China

[4 ]Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Pain Institute, Gannan Medical University, Ganzhou, China

[5 ]GRID grid.440714.2, ISNI 0000 0004 1797 9454, Pain Institute, Gannan Medical University, ; Ganzhou, China

Article

Publisher ID: 3268

DOI: 10.1007/s11255-022-03268-4

PMC ID: 9606041

PubMed ID: 35771315

SO-VID: 81953e3d-9959-4fd0-b25e-60727b242712

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 15 February 2022

Date accepted : 15 May 2022

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: dexmedetomidine,end-stage renal disease,oxidative stress,peritoneal dialysis,ropivacaine

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ScienceOpen disciplines: Nephrology

Keywords: dexmedetomidine, end-stage renal disease, oxidative stress, peritoneal dialysis, ropivacaine

Assessment of the effect of perineural dexmedetomidine on oxidative stress during peritoneal dialysis catheter insertion: a randomized, controlled trial

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Karger: Nephrology

Most cited references 34

The stress response to trauma and surgery

Oxidative stress is progressively enhanced with advancing stages of CKD.

Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current.

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