A comparison of dexmedetomidine and clonidine as an adjuvant to local anaesthesia in supraclavicular brachial plexus block for upper limb surgeries

More, Preeti; Basavaraja,; Laheri, Vandana

doi:10.31254/jmr.2015.1505

Cited by 5 publications

(4 citation statements)

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“…For surgeries on the upper limb, the brachial plexus block is a practical and often employed regional anesthetic method. Although there are many various techniques, we chose the supraclavicular route because it is a straightforward and secure method for administering anesthetic and pain relief during procedures below the shoulder joint 16,17 hence several agents like ketamine, buprenorphine, clonidine and dexamethasone have been applied as anadjuvantstowards the locally available anesthetic drugs for accelerating the onset, prolong the duration and improve the quality of block. 18 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Onset and Interval of Supraclavicular Nerve Block

Devi¹,

Kumar²,

Jamil³

et al. 2023

PJMHS

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Aim: To compare duration and onset of motor and sensory block by using dexmedetomidine and dexamethasone as adjuvant to bupivicaine in supraclavicular brachial plexusblock. Place and duration of study: Department of Anaesthesiology, Surgical Intensive Care & Pain Management, Civil Hospital, Dow University of Health Sciences Karachi from 29th June 2022 to 29th December 2022. Design: Randomized controlled trial study Methodology: Sixty patientswere enrolled in the study that had an elective upper-limb surgery performed under supraclavicular anesthesia of hand, wrist, forearmand elbow were allocated through randomization into two groups. Thirty patients in group A treated with bupivacaine 25 ml of 0.5% with dexamethasone 8mg (2 ML) and 30 in group B treated with bupivicaine 25 ml of 0.5% with dexmedetomidine 1µg/kg (2ml). Patients were observed in post-anesthesiacareunitpost-surgery. Duration of onset of pain was noted by patient’s first request for analgesia. Results:Themean age of patients was 34.88±9.39 years. Mean onset time of sensory and motor block was significantly low in group A than group B. Mean duration of sensory block and motor block was significantly high in group B than group A [813.87±113.72 vs. 752.63±27.96; p=0.006] and [734.13± 84.44 vs533.07±88.38;p=0.0005]. The time to request for 1st rescue analgesic was significantly increased in group B as compare to group A(p=0.0005). Practical Implication: Regional anesthesia in orthopedic procedures is superior to general anesthesia in terms of better postoperative pain relief, less central nervous system depressant effect of drugs and early discharge from hospital. Conclusion:The duration of block prolonged in cases where dexmedetomidine was added to the bupivacaine was longer but onset was reduced in comparison to the dexamethasone cases. Keywords: Brachial plexus block, Supraclavicular block, Dexmedetomidine, Dexamethasone

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Section: Discussionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Onset and Interval of Supraclavicular Nerve Block

Devi¹,

Kumar²,

Jamil³

et al. 2023

PJMHS

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“…The supraclavicular nerve block is a beneficial substitute for general anesthesia in upper limb surgery, as it eliminates the adverse impacts of general anesthetic drugs and upper airway instrumentation. This technique provides complete muscle relaxation, stability of blood pressure during surgery, and pain relief after the operation [4] .…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine versus Midazolam as Local Anesthetic Adjuvants to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper-Limb Vascular Surgeries: A Comparative Study

Youssef,

Diab,

Abdel Mohymen

et al. 2023

International Journal of Medical Arts

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Article informationBackground: The supraclavicular nerve block is a useful alternative to general anesthesia for upper limb surgery. Previous research investigated the effect of adjuvant, but its role in the context of a reduced volume of a local anaesthetic drug under ultrasound-guided blocks remains unknown. Aim of the Study:To determine the enhancing effect of dexmedetomidine or midazolam as a local anaesthetic adjuvant to bupivacaine. Patients and Methods:A prospective double-blind randomized clinical trial, included 90 patients arranged for upper limb vascular surgery. Two groups are comprised; BD group [45 patients]: patients who received ultrasound-guided supraclavicular regional block with injection of 20 ml Bupivacaine 0.25% + 10 ml Lidocaine Hydrochloride 2% + 1µ/kg Dexmedetomidine, and BM group [45 patients]: Patients received ultrasound-guided supraclavicular regional block with an injection of 20 ml Bupivacaine 0.25% + 10 ml Lidocaine Hydrochloride 2% + 50µ/kg Midazolam. The primary outcome was duration of post-operative analgesia. Results:The BD group had a statistically significant longer duration of analgesia compared to the BM group. Patients in the BD group had significantly higher scores on the Ramsay Sedation Scale and VAS starting from 30 and 45 minutes intraoperatively, respectively, and these scores continued to be higher until 6 hours postoperatively. However, there were no significant differences between the two groups regarding blood pressure measurement along the follow-up period. Conclusion:Adding dexmedetomidine to bupivacaine for supraclavicular brachial plexus block was found to be more effective than adding midazolam in extending the duration of both sensory and motor block.

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“…Dexmedetomidine, pharmacologically active d-isomer of medetomidine is a highly specific and selective, potent α2 adrenoceptor agonist with α2:α1 binding selectivity ratio of 1620:1 as compared to 220:1 for clonidine. 7,10,14 There are several studies which have proved that, dexmedetomidine as an adjuvant in nerve blocks extends the duration of analgesia. [12][13][14][15][16][17] The proposed mechanism is by blocking the hyper-polarization activated cation current.…”

Section: Introductionmentioning

confidence: 99%

“…7,10,14 There are several studies which have proved that, dexmedetomidine as an adjuvant in nerve blocks extends the duration of analgesia. [12][13][14][15][16][17] The proposed mechanism is by blocking the hyper-polarization activated cation current.…”

Section: Introductionmentioning

confidence: 99%

Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study

2022

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Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb. Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB. Materials and Methods: A prospective, randomized, and triple-blind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 μg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 μg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P<0.001). The duration of post-operative analgesia was also longer in the BD Group compared with the BF Group (549.43±10.56 vs. 403.69±10.84) P<0.001. BF Group had more requirements of analgesic postoperatively. Conclusion: Addition of dexmedetomidine to bupivacaine prolonged the duration of perineural supraclavicular BPB and improvement of post-operative analgesia than fentanyl without significant side effects in patients undergoing upper limb surgeries.

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A comparison of dexmedetomidine and clonidine as an adjuvant to local anaesthesia in supraclavicular brachial plexus block for upper limb surgeries

Cited by 5 publications

References 0 publications

Comparison of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Onset and Interval of Supraclavicular Nerve Block

Comparison of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Onset and Interval of Supraclavicular Nerve Block

Dexmedetomidine versus Midazolam as Local Anesthetic Adjuvants to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper-Limb Vascular Surgeries: A Comparative Study

Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study

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