Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine in Supraclavicular Brachial Plexus Block: A Prospective, Randomized, Double-blind and Controlled Study (original) (raw)
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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.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Brachial plexus blockade is considered as cornerstone of regional anaesthesia practice. Ropivacaine is a new amide, long acting, pure S (-) enantiomer and local anaesthetic. This study was done to compare clonidine and dexmedetomidine as an adjuvant to 0.75% ropivacaine in supraclavicular brachial plexus block. MATERIALS AND METHODS A prospective randomised double-blind study was done in 80 patients of American Society of Anesthesiologist (ASA) grade I and II undergoing elective upper limb surgeries under supraclavicular block. Patients were randomised into 2 groups. Group 1 (n=40) received 30 mL of 0.75% ropivacaine with clonidine 1 mcg/kg and group 2 (n=40) received 30 mL of 0.75% ropivacaine with dexmedetomidine 1 mcg/kg. Onset and recovery time of sensory and motor block, duration of analgesia and quality of block, haemodynamic variables and level of sedation were studied in two groups. RESULTS Sensory and motor block onset times were shorter in group 2 (onset of sensory block was 4.9 ± 1.08 minutes and onset of motor block was 8.9 ± 1.41 minutes) than in group 1 (onset of sensory block was 10.7 ± 4.05 minutes and onset of motor block took 12.1 ± 4.11 minutes) (p value <0.0001). Sensory and motor block durations and duration of analgesia were longer in group 2 than in group 1 (p<0.0001). Blood pressure and heart rate were lower in group 2 as compared to group 1 (p value <0.0001). The number of patients achieving grade 4 quality of block was higher in group 2 as compared to group 1. CONCLUSION Dexmedetomidine (1 mcg/kg) hastens the onset of sensory and motor block, prolongs the duration of sensory and motor block, enhances the quality of block and sedation and also prolongs duration of analgesia as compared with clonidine (1 mcg/kg) when used as an adjuvant to 0.75% ropivacaine in supraclavicular block.
Anesthesiology and Pain Medicine, 2014
Background: Infraclavicular brachial plexus block is an appropriate approach for distal arm and forearm surgeries. Local anesthetic adjuvant agents are used to improve the quality of nerve blocks. Dexmedetomidine and ketorolac are two different types of adjuvants, which have been used in some studies. Objectives: The purpose of this study was to examine the effects of dexmedetomidine and ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block under ultrasound guide technique. Patients and Methods: In a clinical trial study, 111 ASA class I and II patients who were candidates for elective distal arm and forearm surgeries under ultrasound guided infraclavicular brachial plexus block divided into three 37 patient groups. In dexmedetomidine group, 25 mL of lidocaine 1.5% plus 4 ml of normal saline and 100 mcg of dexmedetomidine was injected. Ketorolac group received 25 mL of Lidocaine 1.5% plus 5 mL of ketorolac, and placebo group received 25 mL of lidocaine 1.5% plus 5 mL of normal saline as local anesthetic solution. Sensory and motor onset blocks, duration of sensory and motor blocks and first time to analgesic request and hemodynamic parameters were all recorded. Results: There were no significant differences in sensory block onset between three groups (P = 0.177). Motor block onset was statistically less in dexmedetomidine compared to ketorolac and placebo groups (both Ps < 0.001). Sensory block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Motor block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Time to first analgesic request after the procedures was longer in ketorolac compared to dexmedetomidine and placebo groups (P = 0.016, P < 0.001 respectively), but it was longer in dexmedetomidine compared to placebo group (P = 0.003). The differences of diastolic blood pressure in-between the 5th to 140th minutes after local anesthetic injection among the 3 groups were statistically significant and dexmedetomidine group shows the most reduction in diastolic blood pressure (P < 0.001). Dexmedetomidine showed the lowest mean arterial pressure (P = 0.016) and heart rate in dexmedetomidine group was significantly lower than ketorolac and placebo groups (P = 0.043). Conclusions: Our study showed that dexmedetomidine had better effects on sensory and motor block duration and motor block onset in comparison with ketorolac, as lidocaine adjuvants in infraclavicular brachial plexus block were present in both protocols. However, the first time to analgesic request by ketorolac was longer than dexmedetomidine.
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 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.
Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block
Journal of Anesthesia & Clinical Research, 2016
Background: Many drugs have been used as adjuvants to local anesthetic agents to prolong the duration of peripheral nerve blocks and decrease the time of onset. In this study we assessed the effect of dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block in terms of onset and duration of sensory and motor blockade, intraoperative sedation, postoperative analgesia, sedation and Complications /side effects if any. Methods: 60 patients of age 18-70 yrs were divided into two equal groups for upper limb surgeries under supraclavicular brachial plexus block. Group BD was given 39 millilitres (ml) of 0.5% Bupivacaine+1 microgram/kg dexmedetomidine; Group BS was given 39 ml of bupivacine+1 ml of saline. The following brachial plexus nerve block parameters were assessed hemodynamic parameters, onset and duration of sensory and motor blockade, Ramsay sedation score, verbal rating score, duration of analgesia, duration for rescue analgesia and number of analgesia given. Results: The onset of sensory blockade was 2.54 minutes less in Group (BD) when compared to Group (BS). The onset of Motor Blockade is 3.26 minutes less in Group (BD) when compared to Group (BS). The duration of sensory blockade is 195.65 minutes more in Group (BD) then Group (BS). The duration of Motor Blockade is 190.33 minutes more in Group (BD) when compared to Group (BS). The duration of Analgesia is 207.83 minutes more in Group (BD) when compared to Group (BS). Ramsay sedation score in Gp (BD)continued to show slightly higher sedation scores at all times including postoperative period in comparison to Gp (BS) (P<0.01). Conclusion: Dexmedetomidine is good adjuvant to local anesthestic agents, as its addition to bupivacaine was associated with prolonged sensory and motor blockade, mild sedation and prolonged analgesia. Satisfactory hemodynamic stability without observed immediate post-operative side effects are other significant qualities related to it.
Pain Research & Management, 2021
Background Brachial plexus block is frequently recommended for upper limb surgeries. Many drugs have been used as adjuvants to prolong the duration of the block. This study aimed to assess the effect of dexmedetomidine with bupivacaine combination and only bupivacaine on sensory and motor block duration time, pain score, and hemodynamic variations in the supraclavicular block in upper extremity orthopedic surgery. Methods This prospective, double-blind clinical trial study was conducted on 60 patients, 20 to 60 years old. Patients were candidates for upper extremity orthopedic surgeries. The sensory and motor block were evaluated by using the pinprick method and the modified Bromage scale. The postoperative pain was assessed by utilizing a visual analog scale. Results The mean onset time of sensory and motor block in patients receiving only bupivacaine was, respectively, 31.03 ± 9.65 min and 24.66 ± 9.2 min, and in the dexmedetomidine receiving group, it was about 21.36 ± 8.34 min a...
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.
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.