Comparison of ropivacaine 0.5% with dexmedetomidine and clonidine as adjuvants in ultrasound-guided infraclavicular brachial plexus block for upper limb surgery (original) (raw)
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2017
Background and Aim: Alpha-2 agonists as adjuvant to local anaesthetic agents for PNB enhance the quality and duration of analgesia. Aim of this prospective, double blind, randomised placebo controlled study was to compare the affect addition of Dexmedetomidine and clonidine to Ropivacaine with respect to onset, peak, and duration of sensory-motor block and duration of analgesia in Supraclavicular brachial plexus block. Materials and methods: Ninety ASA grade I or II patients of either sex, aged 18-60 years age scheduled for elective upper limb surgery were equally divided in three groups (n=30).Group R received 0.75% Ropivacaine 30 ml + 1ml NS, Group RC received 0.75% Ropivacaine 30ml +1μgm/kg of clonidine, Group RD received 0.75% Ropivacaine 30ml + 1μgm/kg of Dexmedetomidine in Supraclavicular plexus block by using nerve locator. Ashish Kumar Narolia, Kanta Bhati, Kuldeep Saini, Anita Pareek, Meera Kumari. To Compare the Effect of Dexmedetomidine and Clonidine as Adjuvant to Ropiva...
2015
Many adjuvants to local anesthetic agents for brachial plexus block are investigated in an attempt to increase the onset and duration of block and to improve postoperative analgesia.The present study was designed to assess clinical utility of adding dexmedetomidine to local anesthetics during peripheral nerve blockade. 120 patients of age 18 -58 yr, of either sex, of ASA grade I/II were randomized into two equal groups of 60 patients each, group R received 20 ml of 0.75% ropivacaine with placebo while patients in group RD received 20 ml of 0.75 % ropivacaine with 50 μg of dexmedetomidine for supraclavicular brachial plexus block using ultrasound guidance. Sensory and motor onset time, sensory and motor block duration, duration of analgesia, sedation scores, hemodynamic changes and any side effect were all recorded and statistically analyzed. Onset of sensory block (8.30 ± 2.62 min vs 11.50 ± 3.14 mins) and establishment of complete motor blockade (11.62 ± 3.39 min vs. 15.18 ± 4.25 m...
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.
INTRODUCTION: Peripheral nerve blockade is a well-accepted concept of comprehensive anaesthetic care. Interscalene brachial plexus block is the preferred regional anaesthesia for upper limb surgeries .Several studies have demonstrated the effects of "dexmedetomidine ", an alpha 2 agonist, in local, spinal, epidural anaesthesia when combined with local anaesthetic Ropivacaine. Dexmedetomidine provides analgesic benefits without major side effects. AIM AND OBJECTIVES: To evaluate additional anaesthetic and analgesic effects derived from administration of dexmedetomidine to ropivacaine to brachial plexus block through Interscalene approach, with respect to onset and duration of sensory blockade,Onset and duration of motor blockade ,Duration and rescue analgesia time, haemodynamics and complications. MATERIALS AND METHODS: 60 patients aged between 18 and 60 years belonging to ASA 1 and ASA 2 divided into two groups. Each group consists of 30 patients. GROUP A: Received 29ml 0.5% ropivacaine with 1ml normal saline. GROUP B: Received 29ml 0.5% ropivacaine with 1µg per kg dexmedetomidine diluted to 1ml with normal saline. After identifying, each patient is given brachial plexus block by interscalene approach using peripheral nerve stimulator. All patients are managed similarly and the effect of onset, duration and field of sensory blockade tested by pinprick test and motor blockade, haemodynamics, complications and post-operative pain evaluated. Rescue analgesia provided with Inj Tramadol 100mg IM. The results obtained were tabulated and analysed. RESULTS: The onset and duration of sensory blockade were faster in group B than group A which was statistically significant. The onset and duration of motor blockade is longer in group B than in group A which was statistically significant. Time of rescue analgesia is significantly prolonged in group B than in group A. This difference was both clinically and statistically significant (<0.001). Conclusion: The addition of dexmedetomidine to ropivacaine solution for brachial plexus block can modify the action of local anaesthetic solution by it's local action. The dosage 1µg per kg used in the study significantly increases the duration of analgesia. There were no clinically significant side effects noted.
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.
Journal of Patan Academy of Health Sciences
Introduction: Supraclavicular brachial plexus block is widely used for perioperative anesthesia and analgesia. Dexmedetomidine is highly selective alpha-2 receptor agonist which provides analgesia, sedation and anxiolysis. Our study aims to evaluate the effect of addtion of dexmedetomidine with bupivacaine and xylocaine with adrenaline in supraclavicular block in upper limb surgeries. Method: This was a comparative study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal among 44 patients randomly assigned in Group-I (N=22, bupivacaine and xylocaine with adrenaline 28 ml + dexmedetomidine 2 ml (1 mcg/kg), and Group-II (N=22, without dexmedetomidine) for ultrasound-guided supraclavicular block for upper limb surgeries. The study was approved by institutional review committee. Onset of sensory and motor block, duration of analgesia, demographics, hemodynamic parameters, and side effects of drug were compared. Pin-prick test and modified Bromage scale were used to ev...
Background: Adjuvants are frequently added to local anaesthetics to prolong analgesia following peripheral nerve blockade. The present study evaluated the effect of adding dexmedetomidine as an adjuvant to 0.5% ropivacaine for ultrasound guided supraclavicular brachial plexus block(SCB) in patients undergoing upper limb orthopaedic surgeries. Material and Methods: The 72 eligible patients randomised into two groups of 36 each by flipping the coin. Those getting heads on the coin received block with dexmedetomidine 1 g/kg (1 mL) with 25 mL ropivacaine 0.5% and those getting tails received 25 mL ropivacaine 0.5% only with 1 mL normal saline. All the patients received Ultrasound guided supraclavicular block under all the aseptic precautions. The various parameters noted were onset of sensory block, onset of motor block, total duration of block and time for first rescue analgesia. The parametric data were expressed as means + standard deviation and one way student t-test was utilised to compute the p-value.A p-value of < 0.05 was taken as significant.
2018
Introduction: Brachial plexus block is more advantageous for routine as well as emergency upper limb surgery. This provides a useful alternative to general anesthesia for upper limb surgeries. Brachial plexus block provides very good intraoperative anesthesia as well as postoperative analgesia without any significant systemic side effects. This study was conducted to compare the perioperative analgesic efficacy of clonidine and dexmedetomidine for supraclavicular brachial plexus block along with levobupivacaine. Material and methods: A randomized double blind controlled study was done on 90 patients of ASA Grade I or II undergoing upper limb surgery. Group L – received levobupivacaine 0.5% (25ml) 125 mg and 1.0 ml normal saline, Group C–received levobupivacaine 0.5% (25ml) 125 mg and 1.0ml (150 microgram) clonidine and Group D – received levobupivacaine 0.5% (25ml) 125 mg and 1.0ml (100 microgram) dexmedetomidine. Onset and duration of both sensory and motor blockade and duration of...
2018
Background: Postoperative analgesia is a sine qua non in current clinical practice. So we are in need for an adjuvant that can prolong the action of local anaesthetics after singleinjection blocks. Dexmedetomidine and clonidine are two commonly used adjuvants. This study was undertaken to assess which among them proved to be a superior analgesic adjuvant in lower doses. Materials and methods: After ethical committee approval study was conducted on 60 patients, aged 18-55 years, posted for upper limb surgery under USG guided supraclavicular brachial plexus block at St.John‘s Hospital, Bangalore. The study was conducted from January 2015-January 2016Prospective randomised double blind study. Preoperative baseline values of heart rate, blood pressure and oxygen saturation was recorded. Brachial plexus block by supraclavicular approach was carried out under USG guidance using strict aseptic precautions. Patients were assigned randomly to one of the two groups using computer generated ta...
Archives of anesthesiology and critical care, 2022
Background: Brachial plexus block is a key technique in anesthesiologist's practice. Ropivacaine is a long acting local anaesthetic, Dexmedetomidine has been included as an adjuvant to enhance block duration. Aim: To elucidate the effect of addition of Dexmedetomidine to Ropivacaine in ultrasound guided parasagittal supraclavicular brachial plexus approach with respect to duration of analgesia, onset and duration of sensorimotor blockade. Methods: A randomized single blinded prospective clinical study was conducted among Forty patients of 20-50yrs, ASA Grade I and II, weighing >60kgs scheduled for elective upper limb orthopedic surgeries. Group RN received 25ml of 0.75% ropivacaine with 1ml normal saline, Group RD received 25ml of 0.75% ropivacaine with 1mcg/kg dexmedetomidine diluted to 1ml. Analgesic efficacy, sensorimotor blockade was determined. Statistical Analysis: Demographic and hemodynamic data was analyzed using student t-test. Unpaired t-test was used to analyze onset, duration of sensorimotor blockade and analgesic duration. Results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant. Results: Analgesic duration was prolonged in Group RD rather than Group RN (646.82 +/-21.56min vs 484.78 +/-15.52min). Group RD had rapid onset of sensory (7.4 +/-1.02min vs 9.9 +/-1.16min) and motor blockade (10.25 +/-1.13min vs 13.28+/-1.22min). Duration of sensory (536.62 +/-9.61min vs 413.79 +/-15.61min) and motor blockade (430.13 +/-11.68min vs 298.12 +/-15.36min) was enhanced in Group RD. Conclusion: Adding Dexmedetomidine to Ropivacaine provided superior analgesia along with rapid onset and longer duration of sensorimotor blockade.