ABSTRACT: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.

Ropivacaine, have been introduced into clinical practice because of their lower toxic effects for heart and central nervous system. Ropivacaine is nearly identical to Bupivacaine in onset of action, quality and duration of sensory block, but it produces lesser duration of motor blockade and has a better safety profile when used for the purpose of spinal anesthesia. This study was aimed to compare the intrathecal efficacy and safety between 3.5 ml, 0.5% heavy Bupivacaine (17.5 mg) and 3.5 ml, 0.75% isobaric Ropivacaine (26.25 mg) for lower limb orthopedic surgeries. MATERIALS AND METHODS: We enrolled 60 patients of ASA (American Society of Anesthesiologists) grade I-II scheduled for elective lower limb orthopedic surgeries under spinal anesthesia for this prospective randomized double blind control trial. The patients were randomized to receive either 17.5 mg of 0.5% hyperbaric Bupivacaine or 26.25 mg of 0.75% isobaric Ropivacaine intrathecally. Intra-operative, characteristics of sensory and motor nerve block, and adverse effect (such as hypotension, bradycardia, nausea, vomiting, shivering or pruritis) were evaluated. RESULTS: Baseline demographic variables were comparable between two groups. 1. Time taken to achieve sensory block to L3 (3.75 minutes with SD of 0.59 vs. 5.29 minutes with SD of 0.85). 2. Mean time for the onset of complete motor block in group A was 6.14 minute with SD of 0.708, where as in group B, it was 12.51 minutes with SD of 0.994. 3. Mean duration of sensory block in group A was 204.20 minutes with SD of 8.81, while in group B it lasted for 152.23 minutes with SD of 8.17. 4. Mean duration of motor block in group a patients was 212.67 minute with SD of 11.17 where as in group B patients, the motor block lasted for a mean duration of 135.13 minutes with SD of 11.68. P value for all above mentioned four observations were calculated to be <0.001, which means it is statistically significant 5. Side effects like hypotension, bradycardia, shivering nausea and vomiting more seen in group I. CONCLUSION: Spinal anesthesia for lower limb orthopedic surgeries with intrathecal 26.25 mg of 0.75% isobaric Ropivacaine has characteristically having delayed onset, with shorter duration of action on the sensory as well as motor nerve roots with lesser side effects when compared to Bupivacaine and hence can be used as an effective and safe alternative to it.