Clonidine, but not Dexamethasone, Prolongs Ropivacaine-Induced Supraclavicular Brachial Plexus Nerve Block Duration

Nasir, Dawood; Gasanova, Irina; Drummond, Shaina; Alexander, John C.; Howard, Jo; Melikman, Emily; Hill, Gary E.; Minhajuddin, Abu; Ogunnaike, Babatunde; Whitten, Charles W.

doi:10.2174/1574884712666170605085508

Cited by 8 publications

(11 citation statements)

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“…The full‐text manuscripts of the remaining 312 studies were assessed. After including studies from hand searches and revision of search, we identified a total of 100 studies for inclusion in this network meta‐analysis [32–131]. The study flow chart is in online Supporting Information Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-eight articles were peer-reviewed and indexed trials[32, 34, 36-38, 42, 44, 53, 54, 58, 59, 63, 66, 69, 72, 75, 79, 81-84, 94, 96, 99, 102, 105, 107, 109, 110, 113-116, 123, 124, 127-129], while 62 articles were peer-reviewed, nonindexed publications [33, 35, 39-41, 43, 45-52, 55-57, 60-62, 64, 65, 67, 68, 70, 73, 74, 76-78, 80, 83, 85-93, 95, 97, 98, 100, 101, 103, 104, 106, 108, 111, 112, 117-122, 125, , 87, 97, 109, 111, 115, 121] and 32 used ropivacaine[36,38,39,49,52,53,56,60,67,74,75,80,81,84,88,92,95,96,102,105,107,108,110,113,114,119,120,123,[127][128][129][130][131].For the primary outcome, sensory block duration, 20 studies were judged to have a low risk of bias[35, 38, 39, 42, 45, 56, 59, 65, 76, 81, 82, 92-94, 107, 110, 113, 115, …”

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confidence: 99%

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Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

et al. 2020

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Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

et al. 2020

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“…Patil et al found that duration of motor block was prolonged in ropivacaine clonidine group over ropivacaine alone, but this study is not compare two adjacents. Nasir et al (24) study compare the dexamethasone (4mg) and clonidine (100 mcg) and showed prolongation of motor block in clonidine group, as compare to our study variation there we used 8 mg dexamethasone and 75 mcg clonidine so variation was due to dose difference.…”

Section: Duration Of Motor Blockmentioning

confidence: 58%

“…The result of our study was accordance to following studies, Noss et al (20) (2014) [20] Choi et al (2014) [19) choi et al study was to compare local anesthetic with dexamethasone , the conclusion of study was perineural administration of dexamethasone prolong block effect without any adverse effect. Nasir et al (24) study showed that clonidine 100 mcg prolonged the duration of analgesia, the variation of study may be due to dose of clonidine which is more in these study and dexamethasone dose was less.…”

Section: Duration Of Motor Blockmentioning

confidence: 69%

Comparative evaluation of dexamethasone and clonidine as an adjuvant to ropivacaine in supraclavicular block

Agarwal

Tiwari

Kushwaha³

2022

ijhs

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Background/Aim: Enhancing the intensity of block by using adjuvant is the mainstay now a days in various regional block for surgery. Our primary objective was to compare the dexamethasone and clonidine as adjuvant to ropivacaine in supraclavicular block. Supraclavicular brachial plexus block provides excellent perioperative analgesia in upper extremity surgeries. Various adjuvants can be added to local anesthetics to enhance the effect of block. The main objective in the management of postoperative pain is minimizing the dose of analgesic to reduce side effects and provide adequate analgesia, shorten hospital stay, reduce hospital cost, and increase patient satisfaction. Methodology: One hundred twenty patients going for elective upper limb surgery of ASA grade I & ASA II in the age group 18 – 60 years were divided in the two groups of 60 each. Groups 1 were given Ropivacaine 0.5% 30 ml with 8 mg Dexamethasone, and Groups II were given Ropivacaine 0.5% 30 ml with 75 mcg Clonidine for supraclavicular block using peripheral nerve stimulator. Onset of sensory and motor block, duration of motor block, duration of analgesia, number of rescue analgesia, sedation score, post-operative pain and adverse effects were observed.

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“…[1822] The mechanism of action of this blockade was due to the action of clonidine inhibiting the action potential of A and C fibers in peripheral nerves. [232425] This study showed that there was a significant prolongation of the mean duration of the motor blockade in the clonidine group as compared to the control group. Pöpping et al .…”

Section: Discussionmentioning

confidence: 77%

Efficacy of clonidine as an additive on the duration of action of brachial plexus block performed under ultrasound and nerve locator guidance: A prospective randomized study

Hrishi

Rao²,

Lionel

2019

Anesth Essays Res

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Background: Clonidine, an alpha 2 agonist, when added to local anesthetics in different regional and neuraxial blocks reduces the onset time, improves the efficacy, and increases the duration of postoperative analgesia. Aims: This study evaluated the effect of bupivacaine clonidine combination in ultrasound and nerve locator-guided supraclavicular brachial plexus block for upper limb surgeries. Settings and Design: This was a prospective, randomized, controlled, double-blind study carried out in a tertiary care center in South India on 50 patients with American Society of Anesthesiologists (ASA) physical status classes I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block. Materials and Methods: Eligible participants were randomized equally to either Group B who received 20 ml of bupivacaine and 7 mL of 2% lignocaine or Group C who received 20 ml of bupivacaine, 7 ml of 2% lignocaine, and 100 μg of clonidine. Statistical Analysis: Continuous outcome variables were tested for statistical significance using Student's t -test, and Mann–Whitney U-test was used for outcomes that were nonnormally distributed. Categorical variables were compared using Fisher's exact test. P <0.05 was considered as statistically significant. Results: The onset of sensory and motor blockade was significantly faster ( P < 0.05) in Group C compared to Group B. The duration of sensory and motor block and the duration of analgesia were significantly longer in Group C ( P < 0.001). The sedation in Group C patients was significantly more ( P < 0.05) when compared to Group B, but none of the sedation scores exceeded 3 on the Ramsay sedation score. Hemodynamic parameters did not differ between groups ( P > 0.05). Conclusion: The inclusion of 100 μg of clonidine with bupivacaine in ultrasound-guided supraclavicular brachial plexus blocks prolongs both sensory and motor blockade. It also provides significant postoperative analgesia and mild sedation which is beneficial in the immediate stressful postoperative period.

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Clonidine, but not Dexamethasone, Prolongs Ropivacaine-Induced Supraclavicular Brachial Plexus Nerve Block Duration

Abstract: The results demonstrated that clonidine significantly prolongs the duration of ropivacaine effects for the postoperative analgesia in patient underwent upper arm surgeries.

Cited by 8 publications

References 0 publications

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

Comparative evaluation of dexamethasone and clonidine as an adjuvant to ropivacaine in supraclavicular block

Efficacy of clonidine as an additive on the duration of action of brachial plexus block performed under ultrasound and nerve locator guidance: A prospective randomized study

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