Comparison of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Abstract

Objective: Brachial plexus block is one of the commonly used anesthetic technique for upper limb procedures in orthopedics. A number of drugs have been used as adjuvants to local anesthetic agents, to prolong the duration and enhance the quality of the block. Some of these are clonidine, dexmedetomidine, ketamine, dexamethasone and magnesium sulfate. We conducted this study to evaluate dexmedetomidine and dexamethasone with respect to the onset and duration of sensorimotor block. Their effects on hemodynamic parameters as well as duration of analgesia after surgery were also recorded. Study Design: Prospective Randomized controlled design. Settings: Anesthesia, ICU and pain management department of Services Hospital/SIMS, Lahore Pakistan. Duration: From 15th September 2019 till 15th March 2020. Methodology: Sixty patients fulfilling the inclusion criteria were enrolled in the study after taking informed written consent for upper limb procedures under supraclavicular brachial plexus block. These patients were divided into two groups BD and BG with 30 patients in each group. Patients in Group BD received 32ml of 0.375% bupivacaine (30 ml) with 100microgram of dexmedetomidine(2ml). Group BG patients received 32ml of 0.375% bupivacaine(30ml) with 8mg of dexamethasone (2ml). The onset and duration of sensory and motor block, time to request for first rescue analgesic and hemodynamic changes in both groups of patients were recorded. Results: The results of our study revealed that the patients in group BD had earlier onset and longer duration of sensory and motor block with minimal hemodynamic changes. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant, in terms of rapid onset and prolonged duration of sensorimotor block and postoperative analgesia after supraclavicular block, with minimal hemodynamic changes.