Perineural Dexmedetomidine Is More Effective Than Clonidine When Added to Local Anesthetic for Supraclavicular Brachial Plexus Block: A Systematic Review and Meta-analysis

Abstract

Compared with clonidine as a local anesthetic adjunct for single-injection SCB, perineural dexmedetomidine enhances sensory, motor, and analgesic block characteristics. These benefits should be weighed against the increased risk of transient bradycardia.

Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series

“…17,18 At the same time, given the need for relatively large injectate volumes to achieve spread, we employed the maximum recommended dose of bupivacaine/ropivacaine in the initial bolus to avoid excessively low local anesthetic concentrations. While the ability of dexamethasone and dexmedetomidine to augment analgesia in ESP blocks is currently unsubstantiated, we chose to add them to the local anesthetic mixture based on data from peripheral nerve blockade [19][20][21] and the principle that opioid sparing is best achieved by using as many multimodal analgesic strategies as possible 2 rather than relying on a single ''silver bullet''.…”

Comparative study of dexmedetomidine and clonidine as an adjunct to levobupivacaine in transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized control study

“…Recently, local anesthetic adjuvants like dexmedetomidine, clonidine and dexamethasone have been the subject of increasing interest as the potential to prolong blockade duration. [9][10][11] The combined use of a local anesthetic agent and adjuvants when, applied in a TAP block, may help to evolve an ideal protocol for pain control after abdominal surgery.…”

Perineural adjuncts for peripheral nerve block

“…The optimal dose of perineural dexmedetomidine, at which the duration of sensory block is maximised and the haemodynamic adverse effects are minimised, has been shown to be 50e60 mg. 11 Meta-analyses have suggested perineural dexmedetomidine to be superior to clonidine in terms of indices of block characteristics, but inferior to dexamethasone (Table 2). 15,16 Compared with clonidine, perineural administration of dexmedetomidine was associated with an increase in the mean duration of analgesia by approximately 3.5 h, sensory block by 3 h, and motor block by 2.75 h. 15 Shortening in the times to onset of sensory and motor block were not clinically significant. Such results may be explained by the more pronounced inhibitory effect dexmedetomidine has on neuronal action potentials compared with clonidine.…”