Pain relief after ambulatory hand surgery: A comparison between dexmedetomidine and clonidine as adjuvant in axillary brachial plexus block: A prospective, double-blinded, randomized controlled study

Abstract

Background:For ages various adjuvants have been tried to prolong axillary brachial plexus block. We compared the effect of adding dexmedetomidine versus clonidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.Materials and Methods:A total of 90 patients (20-40 years) posted for ambulatory elective hand surgery under axillary brachial plexus block were divided into two equal groups (groups ropivacaine dexmedetomidine [RD] and ropivacaine clonidine [RC]) in a randomized, double-blind fashion. In group RD (n = 45) 30 ml 0.5% ropivacaine + 100 μg of dexmedetomidine and group RC (n = 45) 30 ml 0.5% ropivacaine + 75 μg clonidine were administered in axillary plexus block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient.Results:Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group RC. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group RC. Postoperative VAS value at 18 h were significantly lower in group RD (P < 0.05). Intraoperative hemodynamics were insignificantly lower in group RD (P < 0.05) without any appreciable side-effects.Conclusion:It can be concluded that adding dexmedetomidine to axillary plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects.

Effects of adding dexmedetomidine, fentanyl, and verapamil to 0.5% ropivacaine on onset and duration of sensory and motor block in forearm surgeries

“…Bangera et al 14 compared the effects of ropivacaine with/without dexmedetomidine in the axillary block, suggesting that adding dexmedetomidine to ropivacaine would cause faster, longer anesthesia and could be used in the forearm and/or hand surgeries, whose results were consistent with ours. Das et al 25 conducted a study to compare the efficacy of dexmedetomidine and clonidine in hand surgery under axillary block, reporting that adding dexmedetomidine to local anesthetic in the block prolonged the duration of sensory and motor block and reduced overall analgesic use without any adverse effects and providing results consistent with ours. The 2014 study by Zhang et al 26 to evaluate the duration of axillary block following infusion of dexmedetomidine with ropivacaine reflected that the adjuvant was effective in prolonging the duration of axillary block, if added, though complications such as bradycardia and hypotension, and hypertension may be observed and whose results regarding block quality are consistent with ours in which side effects of taking medication did not occur.…”

Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center

“…Dexmedetomidine is a newer drug that has found its way into ASC. The drug is highly attractive because of its excellent analgesic effects while causing minimal depression of respiratory function [84][85][86][87]. However, the drug may cause transient hypertension, bradycardia, and hypotension.…”

“…[14] The anesthetists considered this pharmacokinetic dynamic when a second dose was used to avoid complications such as hypoventilation, airway obstruction, hypoxia, and hypotension [27]. Propofol: Nowadays, propofol is the most intravenous drug used in short duration procedures because of its rapid onset and offset time [28][29][30]. The pain on injection can be easily overcome by adding a little amount of lidocaine to the mixture.…”

“…A foraminoplasty was performed were needed with power drills, trephines, chisels, and rongeurs following published techniques [4,8,[11][12][13]29,30]. If bleeding occurred, a radiofrequency probe (Elliquence®) was used for coagulation [31].…”

Retraction

“…The ten articles listed below,[ 1 2 3 4 5 6 7 8 9 10 ] all with the same corresponding author and published in the Saudi Journal of Anaesthesia from 2014-2018, are being retracted because they have been found to have a number of unattributed sections of content with high rate of similarity from various other articles along with overwhelming evidence of data fabrication. The corresponding author and his institution were contacted and asked to provide the journal with the raw data for these studies but there has been no adequate response within a reasonable timeframe.…”