Randomized Trial of the Use of Dexmedetomidine vs. Propofol after Regional Blockade in Shoulder Surgery Patients in Beach Chair Position


Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine; 2) Propofol would have shorter post anesthesia unit recovery times; and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction; however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.

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Gupta, P. , Wellisch, O. , Kronenfeld, M. , Choueka, J. , Eichenbaum, K. , Pagala, M. , Homel, P. and Feierman, D. (2015) Randomized Trial of the Use of Dexmedetomidine vs. Propofol after Regional Blockade in Shoulder Surgery Patients in Beach Chair Position. Open Journal of Anesthesiology, 5, 187-191. doi: 10.4236/ojanes.2015.58034.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Venn, R.M., Hell, J. and Grounds, R.M. (2000) Respiratory Effects of Dexmedetomidine in the Surgical Patient Requiring Intensive Care. Critical Care, 4, 302-308.
[2] McCulloch, T.J., Liyanagama, K. and Petchell, J. (2010) Relative Hypotension in the Beach-Chair Position: Effects on Middle Cerebral Artery Blood Velocity. Anaesthesia and Intensive Care, 38, 486-491.
[3] Trentman, T.L., Fassett, S.L., Thomas, J.K., Noble, B.N., Renfree, K.J. and Hattrup, S.J. (2011) More Hypotension in Patients Taking Antihypertensives Preoperatively during Shoulder Surgery in the Beach Chair Position. Canadian Journal of Anaesthesia, 58, 993-1000.
[4] (2000) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 284, 3043-3045.
[5] Arain, S.R. and Ebert, T.J. (2002) The Efficacy, Side Effects, and Recovery Characteristics of Dexmedetomidine Versus Propofol When Used for Intraoperative Sedation. Anesthesia and Analgesia, 95, 461-466.
[6] Rohrbaugh, M., Kentor, M.L., Orebaugh, S.L. and Williams, B. (2013) Outcomes of Shoulder Surgery in the Sitting Position with Interscalene Nerve Block: A Single-Center Series. Regional Anesthesia and Pain Medicine, 38, 28-33.
[7] Soeding, P.F., Wang, J., Hoy, G., Jarman, P., Phillips, H., Marks, P. and Royse, C. (2011) The Effect of the Sitting Upright or “Beachchair” Position on Cerebral Blood Flow during Anaesthesia for Shoulder Surgery. Anaesthesia and Intensive Care, 39, 440-448.
[8] Gillespie, R., Shishani, Y., Streit, J., Wanner, J.P., McCrum, C., Syed, T., Haas, A. and Gobezie, R. (2012) The Safety of Controlled Hypotension for Shoulder Arthroscopy in the Beach-Chair Position. Journal of Bone and Joint Surgery (American Volume), 94, 1284-1290.
[9] Koh, J.L., Levin, S.D., Chehab, E.L. and Murphy, G.S. (2013) Neer Award 2012: Cerebral Oxygenation in the Beach Chair Position: A Prospective Study on the Effect of General Anesthesia Compared with Regional Anesthesia and Sedation. Journal of Shoulder and Elbow Surgery, 22, 1325-1331.
[10] Klein, S.M., Evans, H., Nielsen, K.C., Tucker, M.S., Warner, D.S. and Steele, S.M. (2005) Peripheral Nerve Block Techniques for Ambulatory Surgery. Anesthesia and Analgesia, 101, 1663-1676.
[11] Hadzic, A., Williams, B.A., Karaca, P.E., Hobeika, P., Unis, G., Dermksian, J., Yufa, M., Thys, D.M. and Santos, A.C. (2005) For Outpatient Rotator Cuff Surgery, Nerve Block Anesthesia Provides Superior Same-Day Recovery over General Anesthesia. Anesthesiology, 102, 1001-1007.
[12] Dennis, E., Feierman, E.K., Keilin, C., Mark Kronenfeld, M., Rahmani, D., Saberito, D. and Gupta, P. (2015) Chart Review of PACU Outcomes for Patients Who Had Ambulatory Shoulder Surgery with Peripheral Nerve Block (PNB) and General Anesthesia Compared to General Anesthesia (GA). Open Journal of Anesthesilogy, 7, 173-176.

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