Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block (original) (raw)
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Context and aims: Dexmedetomidine is α2 agonist with analgesic, sympatholytic and sedative properties and hence, useful adjuvant in regional anesthesia. We aimed primarily to evaluate the effects of Dexmedetomidine when added in supraclavicular block. Methods and Material: It was a prospective, randomized, double blind, placebo controlled study. Sixty patients of ASA grades I and II undergoing forearm surgeries were randomly allocated into two groups of 30 patients each. Control group C patients received Inj. Bupivacaine (0.5%) 2mg/kg + Inj. Lignocaine (2%) 5mg/kg + Inj. sterile water. Study group D patients received local anesthetics in similar doses + Inj. Dexmedetomidine (1 µgm/kg) + Inj. sterile water. Total volume was 35ml. Parameters noted were onset, peak and duration of sensory and motor block, VAS (Visual analogue scale) score, duration of analgesia, number of rescue analgesics required in first 24 hours post operatively, Ramsay sedation score, vital parameters and complications, if any. Results were analyzed using MedCalc software. Results: Demographic data and surgical characteristics were comparable in both the groups. Onset times for sensory and motor blocks were significantly shorter, (p< 0.001) while the duration of blocks and duration of analgesia were significantly longer (p < 0.001) in group D. Patients in both the groups maintained stable vital parameters with Ramsay sedation score 2/3. Bradycardia was observed in two patients in the group D. Conclusions: Dexmedetomidine can be used as a safe and effective adjuvant to local anesthetics in supraclavicular block to provide excellent peri-operative analgesia with minimal side effects.
Journal of Evolution of Medical and Dental Sciences, 2016
A variety of receptor mediated nociception on peripheral sensory axons and the peripheral administration of appropriate drugs (adjuncts) may have analgesic benefit without the disadvantage of systemic adverse effects and it may also allow reduction in the total dose of local anaesthetic used. Recent studies suggest that α2 agonists when combined with local anaesthetics extends the duration of regional anaesthesia. Thus, in the present study, we investigated the effects of adding dexmedetomidine 50 µg to a 30 mL of local anaesthetic solution in supraclavicular brachial plexus block with respect to onset and duration of motor and sensory block and duration of analgesia. METHODS Sixty patients scheduled for elective forearm surgery were divided into two equal groups in a randomised double blind fashion. In group C (n=30), 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+0.5 mL of normal saline and in group D (n=30) 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+50 µg dexmedetomidine were given for supraclavicular brachial plexus block using peripheral nerve stimulator. Onset and duration of sensory and motor block were assessed along with total duration of analgesia. Demographic and haemodynamic data were subjected to student's t-test and for statistical analysis of onset time and duration of sensory and motor blocks and total duration of analgesia, unpaired t-test was applied. P-value <0.05 was considered as statistically significant and P-value <0.001 as highly significant. RESULTS Dexmedetomidine added as an adjuvant to local anaesthetic agents for supraclavicular block shortens onset time and significantly prolongs the duration of sensory and motor blocks and duration of analgesia.
National Journal of Medical Research, 2017
Introduction: Axillary approach of brachial plexus block provides excellent operating conditions for forearm and hand surgeries with less risk. The α2:α1 selectivity of Dexmedetomidine is eight times that of clonidine and its high specificity for α2 subtype makes it a much more effective as adjuvant. The present study is designed to evaluate the effect of Dexmedetomidine as an adjuvant to 0.5% Ropivacaine hydrochloride with 0.5% Bupivacaine hydrochloride insensory and motor blockade and post operative analgesia axillary brachial plexus block in hand and forearm surgery. Methodology: After institutional ethical committee clearance and informed written consent, prospective randomized controlled study of 60 patients of either sex, aged 18-60 years with ASA grade I, II and III undergoing forearm or hand surgery at SMIMER hospital was done.In Group 1, Inj. 0.5% Bupivacaine hydrochloride 20ml, Inj. 0.5% Ropivacaine hydrochloride 20ml and Inj. Dexmedetomidine (2µg/kg) were given. In Group 2, Inj. 0.5% Bupivacaine hydrochloride 20ml and Inj. 0.5% Ropivacaine hydrochloride 20ml was given. In operation theatre, Sensory blockade was assessed by three modalities. Pain (Pin Prick), Temperature (Alcohol wipe) and Touch (11 Point Scale). Motor Blockage by Lovett rating score, Sedation were assessed by Ramsay Score and Visual Analog Scale for Pain Relief were used. Results: Demographic data like age, sex, weight of patients and surgical characteristics like duration & type of surgery were comparable in both the groups (P>0.05).The duration of motor blockade was significantly prolonged in Group 1 (p<0.01).VAS was comparable in immediate postoperative period upto 10 hrs but after that it became significantly higher in control group across the time. Mean total analgesic requirement (inj. Diclofenac sodium) was significantly less in 48 hours after performing axillary block in Group 1 (250 ± 35.95 mg) as compared to group 2 (405 ± 42.24 mg) (p<0.01). Conclusion: Addition of dexmedetomidine to local anaesthetic agent in peripheral nerve block leads to decreased total consumption of analgesic postoperatively. Furthermore, in axillary brachial plexus block dexmedetomidine significantly prolonged both sensory as well as motor blockade and post operative pain relief.
2015
Background and Objectives: The infraclavicular brachial plexus block is a safe and reliable approach to provide postoperative analgesia of upper limb. We evaluated the efficacy of dexmedetomidine added to local anaesthetics in infraclavicular brachial plexus block to hasten the onset of sensory and motor block and to prolong the Methods: A prospective randomized double@ blind study was carried out in 60 patients aged 18 II , who were scheduled for various upper limb surgeries in orthopedics. The patients were divided into two groups of 30 each i.e . Control Group (gro up C) received 20 ml of inj. Bupivacaine + 10 ml of Xylocaine + 10 ml of Normal Saline and Dexmedetomidine Group (group D) received 20 ml of inj. Bupivacaine + 10 ml of inj. Xylocaine + 10 ml of Normal Saline + 1 µg/kg of inj. Dexmedetomidine. Both gr time of onset of sensory and motor blocks, postoperative analgesia and haemodynamic changes. sensory and motor blockade (2.9 ± 1.0 Vs 8.8 ± 2.22 min and 5.23 ± 1.14 Vs 10...
Journal of Anaesthesiology Clinical Pharmacology, 2017
Background and Aims: The primary aim of this study was to evaluate the effect of addition of dexmedetomidine on the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Material and Methods: Sixty patients of American Society of Anesthesiologists physical status I/II/III undergoing elective upper limb surgeries under supraclavicular brachial plexus block using nerve stimulator were randomized into two groups. Group A (n = 30) received 30 mL 0.5% ropivacaine and 1 mL normal saline, and Group B (n = 30) received 30 mL 0.5% ropivacaine and 1 µg/kg of dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included time to onset and duration of sensory/motor blockade. Statistical Analysis: Results on continuous measurements are presented as mean ± standard deviation and compared using Student's unpaired t-test. Results on categorical measurements are presented in number (%) and compared using Chi-square test. Results: Onset of sensory and motor block in Group A (13.0 ± 4.1 and 23.5 ± 5.6 min) was slower than those in Group B (9.5 ± 5.8 and 15.6 ± 6.3 min; P = 0.009 for sensory and P < 0.001 for the motor block). Duration of sensory and motor block in Group A (400.8 ± 86.6 and 346.9 ± 76.9 min) was shorter than those in Group B (630.6 ± 208.2 and 545.9 ± 224.0 min; (P < 0.001). The duration of analgesia in Group A (411.0 ± 91.2 min) was shorter than that in Group B (805.7 ± 205.9 min; P < 0.001). The incidence of bradycardia and hypotension was higher in Group B than in Group A (P < 0.001). Conclusion: Perineural dexmedetomidine with ropivacaine provides prolonged postoperative analgesia, hastens the onset of sensory and motor block and prolongs the duration of the supraclavicular brachial plexus block.
Journal of Evolution of Medical and Dental Sciences, 2014
Brachial plexus block is a popular and widely employed regional nerve block of upper extremity which avoids the unwanted effect of anesthetic drugs used during general anesthesia, there complication and the stress of laryngoscopy and tracheal intubation. Patients also have a postoperative period free from nausea, vomiting, cerebral depression and immediate post-operative pain. The brachial plexus via supraclavicular approach block provide safe, effective, low cost complete anesthesia or analgesia of the upper extremity and is carried out at the level of the distal trunks/divisions of the brachial plexus, where it is in its tightest formation thus allowing for rapid and completed anesthesia or analgesia of the upper limb. The present single Centre, prospective, randomized, double blind study was undertaken to compare the effects of Ropivacaine and Ropivacaine-Dexmedetomidine combination in brachial plexus block via supraclavicular route with respect to its onset, duration of action. A total of 60 patients of ASA grading I &II and age ranging 18-50 year of either sex underwent various elective upper limb surgeries were divided in two equal groups Group A (n=30): Received brachial plexus block with 30 ml Ropivacaine (0.75%.) Group B (n=30): Received brachial plexus block with 29 ml Ropivacaine (0.75%) + 1 ml Dexmedetomidine (50µg.) After performing supraclavicular block the following observations were made: 1. Onset of sensory blockade. 2. Duration of sensory blockade. 3. Onset of motor blockade. 4. Duration of motor blockade. 5. Duration of analgesia. The onset and duration of sensory blockade was assessed by pin prick response on area of all four nerves of upper limbs. The onset and duration of motor blockade was assessed by Modified Bromage Scale. The onset and duration of analgesia was assessed by response to pin prick and time of first request of analgesic dose. The observations were as follow:-The average time of onset of sensory blockade was 14.20 ±5.229 mins in-group A and 7.20±2.483 mins in-group B. The observed average onset of motor blockade was 21.00±8.566 mins in group A and 11.83±3.824 mins in group B. The average duration of sensory blockade was 310.37±66.359 mins in group A and 435.87±102.309 mins in group B respectively. The average duration of motor blockade was 278.50 ±66.887 mins in group A and 390.47 ±107.868 mins in group B. The average duration of analgesia was 378.53±80.93 min and 970.83±237.623 mins in groups A and B respectively. There was statistical significant difference in terms of onset & duration of sensory, motor blockade and duration of analgesia between the two groups.
International Journal of Advanced Research (IJAR), 2019
Background:Different adjuvants are used with local anesthetics to improve quality of peripheral nerve blocks. The aim of our study was to evaluate the effect of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block with respect to onset of sensory and motor blockade and duration of blockade and analgesia. Patients and Methods: Sixty patients of ASA grade I and II, aged 18-55 years of either sex scheduled for upper limb plastic surgical procedures under supraclavicular brachial plexus block were randomly divided into two equal groups. Patients in control group R (n = 30) received 29 ml of 0.5% ropivacaine with 1ml normal saline (control) and in study group RD (n = 30) received 29 ml of 0.5% ropivacaine with 1 ml (50?g) dexmedetomidine. The onset and duration of sensory and motor block, duration of analgesia were analyzed in both the groups Results:The mean time of onset of sensory blockade were 5.1?0.91 min and 3.2?0.82 min respectively in group R and RD. Whereas time of onset of motor blockade were 11.21?1.81 min and 6.45?0.92 min respectively in group R and RD. The durations of sensory and motor block were 455.31 ? 19.31 and 365 ? 18.41 min respectively in group R, whereas they were 693 ? 11.01 and 656 ? 18.26 min respectively in group RD. The duration of analgesia was 481.31? 16.01 min in group R compared to 718.32 ? 11.25 min in group RD (p<0.001). Statistically significant difference was found between the two groups with respect to their onset and duration of sensory and motor blockade as well as in their total duration of analgesia. Conclusions: We conclude that in supraclavicular brachial plexus block addition of dexmedetomidine to ropivacaine shortens the onset of sensory and motor blockade and prolongs the total duration of sensory and motor block as well as total duration of analgesia.
ANAESTHESIA, PAIN & INTENSIVE CARE , 2017
Objective: To compare the effect of adding two different doses of dexmedetomidine to ropivacaine, on onset and duration of analgesia for supraclavicular brachial plexus block in patients scheduled for upper limb orthopedic surgery. Methodology: This prospective randomized double blind comparative study was conducted at our institution. After ethical committee approval and informed patient consents, 50 patients of ASA I, II and aged 21-60 years, who were scheduled for elective upper limb surgery and were enrolled in the study and randomly divided into two equal groups. They received either 30 ml of 0.75% ropivacaine plus dexmedetomidine (1 µg/kg) diluted with normal saline up to 5 ml (total volume = 35 ml) in Group 1 or 30 ml of 0.75% ropivacaine plus dexmedetomidine (2 µg/kg) diluted with normal saline up to 5 ml (total volume = 35 ml) in Group 2. The onset and duration of sensory and motor block, duration of analgesia, hemodynamic parameters, sedation score, VAS and side effects were recorded. Results: Onset time of sensory and motor block were earlier in Group 2 than in Group 1 (p < 0.001). Duration of sensory and motor block and duration of analgesia were longer in Group 2 than in Group 1 (p < 0.001). There was no significant difference in the incidence of hypotension and bradycardia between both the groups (p > 0.05). There was a statistically significant reduction in number of rescue analgesic doses and total dose consumption in 24 hours in Group 2 than in Group 1. Quantitative data are represented as arithmetic mean and standard deviation and analyzed using Student's t test or ANOVA as per need. Qualitative data are represented as number (proportion or percentage) and analyzed using Chi square test. The levels of significance and α-error were kept 95% and 5% respectively for all statistical analyses. P values < 0.05 were considered significant. ABSTRACT
International Journal of Advanced Research, 2020
To compare and evaluate the onset time and duration of sensory, motor block, and quality of intraoperative and postoperative analgesia of dexmedetomidine and dexamethasone as adjuvants to local anesthetics in brachial plexus block. Methods: This was a prospective comparative study conducted among 60 adult patients aged 18-60yrs belonging to asa 1& 2 posted for upper limb surgeries. 1. Group-a: 20ml of 2% lignocaine with adrenaline + 20ml of 0.5% bupivacaine+ 20mcgs of dexmeditomedine. 2. Group-b: 20ml of 2% lignocaine with adrenaline + 20ml of 0.5% bupivacaine+ 4mg dexamethasone. Results: The groups were similar in age, hemodynamic parameters like intra and post-operative heart rate, mean arterial pressure. In this study, the onset and duration of sensory and motor blockade were statistically shorter in the dexamethasone group when compared to the dexmedetomidine group. Conclusion: The present study concludes both dexmedetomidine and dexamethasone act as functional additives with dexmedetomidine having the advantage of conscious sedation and hemodynamic stability prolongs the duration of block whereas the onset of the block was shorter when dexamethasone was added.
Journal of Research in Medical and Dental Science, 2015
Background: Among alpha 2 adrenergic agonists the role of Clonidine as an adjuvant to local anaesthetics to prolong duration of block is extensively studied but effect of Dexmedetomidine as an adjuvant to local anaesthetics in brachial plexus block is not much investigated. Aim: To compare effects of Clonidine and Dexmedetomidine with inj. Ropivacaine 0.5% in brachial plexus block with regard to block characteristics, post operative analgesia, hemodynamic stability and complications. Materials and Methods: 50 patients of ASA gr I and II undergoing upper extremity surgeries were selected and randomized to receive Clonidine(group RC) or Dexmedetomidine(group RD) with inj. Ropivacaine 0.5% 30 ml in supraclavicular brachial plexus block .Onset and duration of sensory and motor blockade, duration of post operative analgesia, hemodynamic parameters and adverse effects were compared. Results: Significant difference was observed in relation to duration of sensory block 346.8(±74.54) minutes in group RC and 540 (±56.12) min in group RD, duration of motor block 386.4(±67.82) min. and 586.8 (±55.51) min. respectively. Duration of post operative analgesia 372(±70.86) min in group RC and 559 (±55.40) min in group RD. No significant difference was observed in onset of sensory block which is 11.92(±2.55) min in group RC and 11.36(±2.14) min in group RD and onset of motor block which is 18.56(±2.12) min in group RC and 17.28(±2.70) min in group RD. Conclusion: The duration of sensory motor blockade and post operative analgesia was significantly prolonged by Dexmedetomidine with inj Ropivacaine in brachial plexus block without significant hemodynamic alterations.