A double blind randomized study to assess the addition of clonidine to ropivacaine in supraclavicular brachial plexus block

Abstract

INTRODUCTIONBlocking of supraclavicular brachial plexus during upper limb surgeries was found to be very effective in producing anaesthesia and analgesia. This type of peripheral nerve blocks provide intraoperative and postoperative analgesia without any systemic sideeffects.1 Ropivacaineis an amide, local anaesthetic agent, eliciting nerve block via reversible inhibition of sodium influx in nerve fibres. A clinically adequate dose of ropivacaine with its efficacy, lower propensity for motor block and reduced potential for CNS and cardiac toxicity than bupivacaine, appears to be an important option for regional anaesthesia for upper limb surgeries.2 Concurrent administration of adjuvants like clonidine to local anaesthetics in brachial plexus block may enhance the quality and duration of analgesia. The purpose of our study was to determine the efficacy of clonidine as an adjuvant to ropivacaine for supraclavicular brachial plexus block in terms of onset, duration, degree of sensory and motor blockade, postoperative analgesia and any complications if produced. ABSTRACT Background:The supraclavicular brachial plexus block provides anesthesia of the entire upper extremity in consistent and time-efficient manner. Ropivacaine is an amide, local anaesthetic agent, eliciting nerve block in brachial plexus. Clonidine as an adjuvant to ropivacaine enhances the quality and duration of analgesia when given epidurally or intrathecally. The aim of the present study was to assess the effect of adding clonidine to ropivacaine in supraclavicular brachial plexus block. Methods: Sixty patients were randomly divided into two groups, Group C and R. Group C received 0.5% of ropivacaine with 1 ml normal saline while Group R received same amount of ropivacaine with 1 ml (equivalent to 100μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia, intra and post-operative hemodynamic changes and sedation scores. Results: There was a significant increase in duration of sensory and motor block and duration of analgesia in Group C as compared to Group R (P<0.001). There was no significant difference in mean onset time for sensory and motor blockade, the hemodynamic parameters (pulse rate, diastolic and systolic blood pressure)during and after surgery, sedation score post operatively in either groups (P>0.05). Conclusions: Clonidine 100µg added to 0.5% ropivacaine for supraclavicular brachial plexus block, does not shorten the onset of sensory and motor blockade but the combination produced prolonged sensory and motor blockade, improved and prolonged duration of analgesia, thereby decreasing the need for systemic analgesics without any hemodynamic changes.

A Comparison Between Dexamethasone and Clonidine as Adjuvants to Levobupivacaine in the Supraclavicular Approach to the Brachial Plexus Block: A Double-Blind Study

“…Our results for group LC are also comparable with various other studies done by Rohan et al [19], Ali et al [20], Kohli et al [21], and Kulkarni et al [22], who also documented a significant prolongation of sensory and motor blockade without any alteration in hemodynamic stability with the addition of clonidine to local anesthetics used in BPB.…”

“…In our study, the baseline sedation score was 2 according to the Ramsay sedation scale when patients were taken in the operation theater (OT) (before any anesthetic intervention), as all patients were calm and cooperative, and the sedation score remained the same throughout the procedure; similar findings were seen in earlier studies [18,19]. However, several previous studies [19][20][21][22] had shown a high level of sedation with clonidine, which might be due to higher doses of clonidine used in their study.…”