Comparison of Levobupivacaine and Levobupivacaine with Dexmedetomidine for Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries-A Randomised Controlled Trial

Abstract

Introduction: Brachial plexus blockade at the supraclavicular level delivers an excellent regional anaesthetic technique with unmatched effectiveness for upper limb surgeries. Levobupivacaine, a safer alternative to the commonly used bupivacaine for regional anaesthesia and addition of α2-agonists like dexmedetomidine further improves the quality of regional anaesthesia. Aim: To evaluate the efficacy of levobupivacaine in combination with dexmedetomidine for supraclavicular brachial plexus block. Materials and Methods: This randomised controlled study enrolled 50 American Society of Anaesthesiologist (ASA) grade I and II patients aged between 18-60 years posted for elective upper limb surgeries. Randomisation was done and the patients were divided into two groups with 25 each, to receive either 39 mL of 0.5% levobupivacaine and 100 μgs (1 mL) of dexmedetomidine in group LD (Levobupivacaine with Dexmedetomidine) and 39 mL of 0.5% levobupivacaine and 1 mL of normal saline in group LS (Levobupivacaine with Saline). The onset and duration of sensory and motor blockade along with duration of analgesia were observed. All Quantitative data were compared and analysed using student’s unpaired t test while qualitative data were analysed using Chi-square test. A p-value of less than 0.05 was considered to be statistically significant. Results: The onset of sensory and motor blockade in group LD was significantly faster when compared to group LS (p<0.001). group LD had a longer mean duration of sensory and motor blockade along with duration of analgesia when compared to group LS (p<0.001). There was a better hemodynamic stability in group LD when compared to group LS. Conclusion: Dexmedetomidine added to levobupivacaine provides significantly shorter onset times, greatly prolongs the duration of sensory and motor blockade along with duration of analgesia without any systemic side effects.

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”