Clonidine as an adjuvant to ropivacaine-induced supraclavicular brachial plexus block for upper limb surgeries

Patil, Kalyani Nilesh; Singh, Noopur Dasmit

doi:10.4103/0970-9185.161674

Cited by 27 publications

(20 citation statements)

References 24 publications

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“…The systemic adverse events observed in other studies range from no side effects [ 3 , 5 , 14 , 30 ] to mild sedation [ 20 ] lower heart rate [ 2 , 20 , 35 ] and lower blood pressure [ 2 , 20 ], and are consistent with our results. These hemodynamic changes are primarily observed during the first four hours.…”

Section: Discussionsupporting

confidence: 93%

Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers

et al. 2017

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BackgroundClonidine used as an adjuvant to ropivacaine have been shown to prolong the duration of peripheral nerve blocks. The mechanism of action remains unclear. We hypothesized, that clonidine used as an adjuvant to ropivacaine extends the duration of an adductor canal block (ACB) by a peripheral mechanism, compared to ropivacaine alone when controlling for systemic effects.MethodsWe conducted a paired, blinded, randomized trial in healthy volunteers. Participants received bilateral ACBs containing 20 ml ropivacaine 0.5% + 1 ml clonidine 150μg/ml in one leg and 20 ml ropivacaine 0.5% + 1 ml saline in the other leg. The primary outcome measure was duration of sensory block assessed by temperature sensation (alcohol swab). Secondary outcome measures were duration of sensory block assessed by: pinprick, maximum pain during tonic heat stimulation, warmth detection threshold and heat pain detection threshold.ResultsWe enrolled 21 volunteers and all completed the trial. There was no difference in duration of sensory block assessed with an alcohol swab: Mean duration in the leg receiving ropivacaine + clonidine was 19.4h (SD 2.7) compared to 19.3h (SD 2.4) in the leg receiving ropivacaine + placebo with a mean difference of 0.1h (95% CI: -1.0 to 1.3), P = 0.83. No differences in block duration were detected when assessed by: Pinprick, mean difference 0.0 h (95% CI: -1.3 to 1.3), maximum pain during tonic heat stimulation, mean difference -0.7 h (95% CI: -2.1 to 0.8), warmth detection threshold, mean difference -0.1 h (95% CI: -1.8 to 1.6) or heat pain detection threshold, mean difference -0.2 h (95% CI: -1.7 to 1.4).ConclusionsAdministering clonidine perineurally as an adjuvant to ropivacaine in an ACB did not prolong the duration of sensory block in a setup controlling for systemic effects of clonidine.

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Section: Discussionsupporting

confidence: 93%

Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers

et al. 2017

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“…p value<0.001. These results were comparable with those obtained in the studies conducted by Kalyani Nilesh Patil et alUsha Bafna et al [9,14] .…”

Section: Sensory Block Time Of Onset Of Sensorysupporting

confidence: 92%

A clinical study of effects of clonidine as adjuvant with ropivacaine in ultrasound guided axillary brachial plexus block

Patel¹,

B²,

BT³

2020

Int. J. Med. Anesthesiology

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Background: Axillary Brachial plexus block is the distal block performed on the brachial plexus. With the advent of ultrasound guidance establishing the blockade has been easier with reduced drug dosage and less complications. Objective: To evaluate and compare the effects of addition of clonidine with ropivacaine for axillary block with reference to a) onset of sensory blockade b) onset of motor blockade c) duration of analgesia. Methods: 60 patients of ASA class 1& 2 for upper limb surgical procedures were randomly allocated into two groups of 30 each, Group P will receive ropivacaine 0.75% 20ml + NaCl 0.9% (0.5ml) Group D will receive ropivacaine 0.75% 20ml + clonidine 75µg (0.5ml). With ultrasound guidance axillary brachial plexus block was administered. Testing for onset of sensory blockade was done using pin prick method, Motor block was assessed using modified Bromage scale, Post operatively patients would be assessed for the duration of sensory and motor blockade. Results: The present study shows that 20 ml of 0.75% Ropivacaine with clonidine 75 mcg prolonged the duration of motor, sensory block and duration of analgesia when compared with 20 ml of 0.75% Ropivacaine with NaCl 0.9% .The onset of sensory, motor blocks was significantly faster with 0.75% Ropivacaine with clonidine 75 mcg group (Group D) when compared with 0.75% Ropivacaine with NaCl 0.9% group (Group P). Conclusion: Clonidine 75 µg as an adjuvant to 0.75% ropivacaine produces satisfactory onset of sensory and motor blockade, with increased duration of analgesia when used for axillary brachial plexus block under ultrasound guidance without any adverse effects.

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“…These observations were consistent with the reviews done by different authors. 7,8,16 Similarly, reduction of SBP was seen both with clonidine and dexmedetomidine but was not clinically detrimental for the patient and attributed to the decreased bleeding in the surgical field. Patients were mildly sedated and arousable on command in all the other studies and was independent of local anaesthetic used.…”

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confidence: 99%

Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block

et al. 2017

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INTRODUCTIONThe use of USG (ultrasound) guided peripheral nerve block is a relatively new technique that is rapidly gaining popularity over more traditional techniques of peripheral nerve stimulators and parasthesia.1 Use of ultrasound not only avoids the injury to the nerves associated with blind paraesthesia technique but also decreases the total dose ABSTRACT Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block. Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher's exact test. Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block. Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.

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Clonidine as an adjuvant to ropivacaine-induced supraclavicular brachial plexus block for upper limb surgeries

Cited by 27 publications

References 24 publications

Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers

Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers

A clinical study of effects of clonidine as adjuvant with ropivacaine in ultrasound guided axillary brachial plexus block

Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block

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