Comparison of clonidine and dexmedetomidine as adjuvants for ropivacaine in supraclavicular brachial plexus block

Abstract

Background: Addition of adjuvants to local anaesthetic in supraclavicular brachial plexus block helps in improving duration of block and analgesia. We compare clonidine and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block.Method: A total of 75 patients aged from 20 to 60 years belonging to ASA I-II scheduled for upper limb surgery were included and divided into three groups-Group I received 0.5% ropivacaine plus normal saline, Group II received 0.5% ropivacaine plus clonidine and Group III received 0.5% ropivacaine plus dexmedetomidine. The patients were compared for onset as well as duration of sensory and motor blockade, duration of analgesia and haemodynamic side effects. Results:The mean duration of sensory and motor block as well as analgesia was found to be more (statistically highly significant p<0.001) in group III (dexmedetomidine group) having a much longer duration of sensory and motor block as well as analgesia compared to group I (plain ropivacaine) and group II (clonidine group). Conclusion:Therefore, in present study it was found that addition of clonidine and dexmedetomidine to 0.5% ropivacaine are effective in supraclavicular brachial plexus block. However, dexmedetomidine is a better alternative to clonidine as adjuvant for 0.5% ropivacaine in to obtain early onset and prolong the duration of sensory and motor block and postoperative analgesia.

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

“…Across all included studies, a total of 3332 patients were assessed. DEX was used as an adjuvant to several different local anesthetics, which included ropivacaine [ 23 , 34 , 39 , 41 , 42 , 45 – 47 , 49 , 50 , 52 , 56 , 57 , 59 , 63 – 66 , 68 , 72 – 74 , 76 , 78 , 80 , 81 , 84 , 85 ], bupivacaine [ 20 , 35 , 37 , 38 , 40 , 51 , 53 – 55 , 67 , 69 , 71 ], levobupivacaine [ 21 , 43 , 44 , 48 , 60 – 62 , 79 , 83 ], and lidocaine [ 22 , 36 , 70 , 77 , 86 ]. Across the studies, the dose of DEX ranged from 0.5 μg/kg to a total of 150 μg.…”

“…The duration of analgesia was assessed by 50 studies [ 20 – 22 , 34 – 49 , 51 – 57 , 59 – 63 , 65 – 72 , 75 , 76 , 78 – 84 , 86 ], all of them ( n = 3218) had sufficient information to allow for pooling. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of duration of analgesia with ≤60 μg and >60 μg DEX were 220.31 (153.13 to 287.48) minutes and 68.01 (36.37 to 99.66) minutes, respectively (test for subgroup difference: P <0.0001) (Additional file 1 ).…”

Alpha2‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses

“…45,[63][64][65]78,80 Nineteen trials compared dexmedetomidine with clonidine in 1130 patients. 31,42,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] Different doses of adjuvants were compared in seven trials. 17,22,30,40,62,64,86 One trial tested clonidine with different local anaesthetics 25 (Table 1).…”

“…The summarized risk of bias was high in 26 trials , [12][13][14][15]22,31,33,38,43,46,50,53,56,57,59,60,63,70,72,73,75,77,81,87,96,104 unclear in 71 5,6,16−21,23−30,32,34−36,39−42,44,47−49,51,52,54,55,58,61,64−67,69,71,74,76,78−80, 82−86,88−95,97−101,103,105−111 trials and low in four trials (Figures 2-4). 37,45,62,68 All but four trials 30,41,61,78 included less than 100 patients.…”

“…The duration of BPB was 205 min (TSA adj. 95% CI 162, 249; p < .00001; 1030 patients; 19 trials) 31,42,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] longer for dexmedetomidine compared with clonidine (weighted mean duration in clonidine group 481 min) (Figure 4, Appendix S7 and Table 2).…”