Randomized Comparison of Extrafascial Versus Subfascial Injection of Local Anesthetic During Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block.Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher’s exact test.Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block.Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.

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A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0008 ◽

2016 ◽

Vol 1 (1) ◽

pp. 30-31

Author(s):

Sindil Kumar Sahu ◽

Usha Badole

Keyword(s):

Brachial Plexus ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Brachial Plexus Block ◽

Rare Complication ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Ultrasound Guided ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

ABSTRACT Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block. How to cite the article Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.

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A comparative clinical study of perineural administration of 0.75% ropivacaine with and without dexmedetomidinein upper limb surgery by ultrasound guided single injection supraclavicular brachial plexus block

Global Anesthesia and Perioperative Medicine ◽

10.15761/gapm.1000133 ◽

2015 ◽

Vol 1 (5) ◽

Cited By ~ 3

Author(s):

Prashant Tiwari ◽

Manish ain ◽

Bhawana Rastogi ◽

Salony aggarwal ◽

Kumkum Gupta ◽

...

Keyword(s):

Clinical Study ◽

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Single Injection ◽

Ultrasound Guided ◽

Upper Limb Surgery ◽

Comparative Clinical Study ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

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A COMPARATIVE STUDY OF ROPIVACAINE VERSUS ROPIVACAINE WITH DEXMEDETOMIDINE AS AN ADJUVANT IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

10.36106/paripex/8010885 ◽

2021 ◽

pp. 138-142

Author(s):

Deba Gopal Pathak ◽

Dipanjali Nath

Keyword(s):

Side Effects ◽

Brachial Plexus ◽

Upper Limb ◽

Local Anesthetic ◽

Brachial Plexus Block ◽

Onset Time ◽

Sensory Blockade ◽

Suitable Alternative ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

BACKGROUND : Supraclavicular approach to brachial plexus block is a versatile and reliable regional anesthesia technique and a suitable alternative to general anesthesia for upper limb surgical procedures. Ropivacaine , a long acting local anesthetic, with less tendency for neurotoxicity and cardiotoxicity is a great local anesthetic for the procedure. Use of adjuvant Dexmedetomidine , a potent alpha 2 adrenoreceptor agonist improves the quality of anesthesia as well as intra-operative and post-operative analgesia while maintaining haemodynamic stability, arousable sedation and mild respiratory depression. MATERIALS AND METHODS: Eighty patients aged between 18 and 60 years with ASA grade I or II posted for elective upper limb surgeries were included in the study and were randomly divided into 2 groups with forty patients in each. Group A received 0.5% ropivacaine (31 mL) and Group B received 0.5% ropivacaine + dexmedetomidine 1microgram/kg (31mL). Both groups were compared for onset time and duration of sensory blockade, onset time and duration of motor blockade , total duration of analgesia and associated side effects. CONCLUSION : Dexmedetomidine as an adjuvant to ropivacaine in the supraclavicular brachial plexus block for upper limb surgeries , significantly shortens the onset time and prolongs the duration of sensory and motor blocks, with longer duration of post-operative analgesia , with associated significant sedation and a few manageable side effects like bradycardia and hypotension.

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