Comparative evaluation of efficacy of two doses of dexmedetomidine as adjuvant to ropivacaine ultrasound guided supraclavicular brachial plexus block

Jalaja Praveena Badugu, Rama Rao Mokkarala

Abstract

Background: Dexmedetomidine as neuraxial adjuvant decreased postoperative pain intensity, prolonged analgesic duration. But use of dexmedetomidine is associated with doses dependent increase in adverse effect like hypertension, hypotension, bradycardia, excessive sedation, sleepiness. Optimal dose of dexmedetomidine is still uncertain. Present study has been designed with an aim to evaluation of efficacy of two doses of dexmedetomidine as adjuvant to ropivacaine ultrasound guided supraclavicular brachial plexus block.

Methods: The patients were randomly divided in to two groups. Group A were received 15 ml of 0.5% ropivacaine with 50 µg one ml dexmedetomidine. Group B were received 15 ml of 0.5% of ropivacaine with 100 µg of dexmedetomidine. Parameters observed were onset of motor block, onset of sensory block, duration of sensory block, duration of motor block. Adverse drug reaction like hypertension, hypotension, bradycardia and sedation were recorded.

Results: We have observed that mean duration of analgesia was longer in group B than group A (650.54±98.54 min versus 702.22±80.24 min) but the difference is not significant statistically (p=0.08). Time for requirement of rescue analgesia was longer in group B than group A (713.45±96.21 min versus 789.23±99.23 min) but the difference is significant statistically (p=0.04).

Conclusions: From present study we can conclude that 100 µg dexmedetomidine as adjuvant to ropivacaine is no significantly better that reducing time of onset of sensory and motor block and prolongation of motor and sensory block. Duration of analgesia was comparable in both doses but time required for rescue analgesia was significantly longer higher dose group.

Keywords

Dexmedetomidine, Ropivacaine, Supraclavicular brachial plexus block

Full Text:

PDF

References

Kulenkampff D. Brachial plexus anaesthesia: its indications, technique, and dangers. Ann Surg. 1928;87(6):883-91.

Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. AnesthAnalg. 1994;78(3):507-13.

Hashim, R.M., Hassan, R.M. The efficacy of adjuvants to bupivacaine in ultrasound-guided supraclavicular block: a comparative study between dexmedetomidine, ketamine, and fentanyl. Ain-Shams J Anesthesiol. 2019;11:19.

Swami S, Keniya V, Ladi S, Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: a randomised double-blind prospective study. Indian J Anaesth. 2012;56(3):243-9.

Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. AnesthAnalg. 2000;90:1122-8.

Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(4):e5846.

Marhofer D, Kettner SC, Marhofer P. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013;110:438-42.

Wu HH, Wang HT, Jin JJ. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? a systematic review and meta-analysis. PLoS One. 2014;9:e93114.

Cai H, Fan X, Feng P. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials. BMC Anesthesiol. 2021;21:233.

Marhofer D, Kettner SC, Marhofer P. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013;110:438-42.

Zhang Y, Wang CS, Shi JH. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block. Int J Clin Exp Med. 2014;7:680-5.

Hollmén A. Axillary plexus block. A double blind study of 59 cases using mepivacaine and LAC‐43. ActaAnaesthesiologicaScandinavica. 1966;10(XXI):53-65.

Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders. 1978;144.

Katz J, Melzack R. Measurement of pain. SurgClin North Am. 1999;79:231-52.

Nallam SR, Chiruvella S, Karanam S. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial. Indian J Anaesth. 2017;61:256-61.

Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res. 2012;2:67-9.

Sinha C, Kumar A, Kumari P, Singh AK, Sharma S, Kumar A et al. Comparison of Two Doses of Dexmedetomidine for Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial. Anesth Essays Res. 2018;12(2):470-4.

Halder S, Das A, Mandal D, Chandra M, Ray S, Biswas MR et al. Effect of different doses of dexmedetomidine as adjuvant in bupivacaine -induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study. J Clin Diagn Res. 2014;8(11):GC01-6.

Eisanach JC, De Kock M, Klimscha W. α2 adrenergic agonists for regional anesthesia. Anesthesiology. 1996;85:655-74.