INTRODUCTIONRegional anesthesia is one of the most challenging and satisfying modalities for anaesthesiologist. The use of peripheral nerve blocks for anesthesia and post op analgesia has increased frequently in recent years. Upper extremities orthopaedic surgeries can be performed safely in brachial plexus block as sole anaesthesia and offers many advantage over general anaesthesia, such as improved postoperative pain relief, early recovery, less PONV and no or minimal systemic side effects of anaesthesia drugs and analgesics. 1,2 Brachial plexus block given by different approaches like axillary, supraclavicular, infraclavicular and interscalene block. But among all approaches, Supraclavicular block for forearm surgeries provide consistent, reliable, complete and uniform upper extremity anaesthesia with ABSTRACT Background: Dexmedetomidine has anxiolytic, sedative, hypnosis, analgesic, antisialogogue and sympatholytic properties which render it suitable as an adjuvant. Hence this study was aimed to prove its efficacy as an adjuvant to lignocaine and bupivacaine for supraclavicular block in patients undergoing orthopedic upper limb surgeries. Other objectives of the study were to evaluate and compare the onset and duration of sensory and motor block as well as total analgesia, to compare effect on hemodynamic and respiratory parameters and to study any adverse effect associated with dexmedetomidine as adjuvant. Methods: Sixty patients of ASA physical status class I & II of elective upper limb forearm orthopedic surgeries were selected in our study. Patients in group NS (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 ml normal saline for supraclavicular block and group D (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 µg/kg of Dexmedetomidine for the same block. The onset and duration of sensory and motor block, total duration of analgesia, need of rescue analgesic postoperatively, postoperative VAS score was assessed and compared between the two groups. Results: Demographic data and surgical characteristics are comparable in both the groups. The onset of sensory and motor block was significantly lower (p <0.05) in group D than in group NS. The duration of sensory and motor block was significantly higher (p <0.01) in group D when compared to group NS. The duration of analgesic requirement postoperatively was significantly higher (p <0.01) in group D than group NS. No significant change in observations was made for hemodynamic parameters in both the groups. Conclusions: Dexmedetomidine can be considered as an adjuvant to lignocaine and bupivacaine mixture for excellent quality supraclavicular block without any side effects and provide good sedation in patients undergoing orthopedic upper limb surgeries.

Background: Choice of premedication and hemodynamic stability are always remain important concerns during laryngoscopy and endotracheal intubation for Anesthesiologists. Dexmedetomidine offers anxiolytic, sedation, hypnosis, analgesia, antisialagogue action as well as sympatholysis which make most suitable drug as premedication. Our aims for this study to evaluate efficacy of Injection Dexmedetomidine 1µg/kg intravenously as premedication on attenuation of hemodynamic changes to laryngoscopy and intubation as well as requirement of injection Propofol as an induction agent. Methods: In Present study, 60 patients of ASA I, II of age 18 to 45 years were randomly divided in to two groups of 30 each. In group NS, 10 ml normal saline and in group D1 injection Dexmedetomidine 1µg/kg diluted in 10 ml of normal saline was used. In both groups study solutions administered over 10 minutes. Both the groups were administered standard general anaesthesia and requirement of Propofol was noted as an induction agent. Heart rate, blood pressure (systolic, diastolic and mean arterial pressure) were compared at baseline, 2 min, 5 min, 10 minutes (SD2, SD5, SD10) after study drugs administration, before induction (BI), after induction (AI), 1 minute (T1), 2 minutes (T2), 5 minutes (T5) and 10 minutes (T10) after laryngoscopy and intubation in both groups. Results: HR, SBP, DBP and MAP highly significantly reduced at 2 min, 5 min and 10 minutes after infusion of Dexmedetomidine in group D1 as compared to group NS. (P<0.01). After induction values are highly significant in group D1 than group NS from baseline (P<0.01). Highly significant mean rise in hemodynamic parameters (HR, SBP, DBP and MAP) from baseline were observed in group NS compared to group D1 after laryngoscopy and intubation (P<0.01). Induction dose requirement of inj. Propofol significantly reduced in group D1 compared to other group (P<0.01). Conclusions: Injection Dexmedetomidine 1µg/kg provides effective and complete attenuation of pressure response to laryngoscopy and endotracheal intubation as premedication with decreased requirement of inj. Propofol for induction without any side effects.

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