Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Supraclavicular Brachial Plexus Block: A Comparative Randomised Prospective Controlled Study

Abstract

BACKGROUND:There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anesthesia. AIMS AND OBJECTIVES: This study was conducted to evaluate and compare the onset, duration of sensory and motor blockade along with the duration of analgesia between dexmedetomidine and clonidine when administered along with 0.5% levobupivacaine in supraclavicular brachial plexus block for upper limb orthopaedic surgeries. MATERIALS AND METHODS: A prospective randomized study was carried out in the department of Anaesthesia at Rajarajeswari Medical College and Hospital which included 50 adult patients between the ages of 20 and 50 years (of ASA I/II grade) who underwent upper limb orthopaedic surgeries. The patients were randomly allocated into two groups; levobupivacaine + dexmedetomidine (LD) and levobupivacaine + clonidine (LC), comprising of 25 patients each. Group LD was administered 30 ml of 0.5% levobupivacaine and 1µg/kg of dexmedetomidine, while group LC received admixture of 30 ml of 0.5% levobupivacaine and 1 µg/kg of Clonidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed. STATISTICAL ANALYSIS: Statistical analysis was done using student t test, chi-square test and Fisher Exact test. The Statistical Software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Sysatat 12.0 and R environment ver.2.11.1 were also used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. The value of P <0.05 was considered significant and P < 0.001 as highly significant. RESULTS: The onset of sensory and motor blockade was faster in Group LD when compared to Group LC. The duration of sensory blockade, motor blockade and analgesia was longer in Group LD when compared to Group LC (p <0.001). Sedation scores were better in LD group. (p<0.05). CONCLUSION: Dexmedetomidine is a better adjuvant than Clonidine when added to Levobupivacaine in supraclavicular brachial plexus block as it prolongs the duration of sensory and motor blockade as well as the duration of analgesia.