Comparative study of (0.5%) levobupivacaine and (0.75%) ropivacaine in supraclavicular brachial plexus block by lateral approach

Background: As compared to general anaesthesia, brachial plexus block for upper limb surgery gives fewer side effects and better postoperative analgesia. The objective of this study was to evaluate the effects of 0.5% levobupivacaine and compare it with 0.75% ropivacaine.Methods: For this prospective randomized, controlled study, 60 patients of both sexes of ASA grade 1 and 2 were enrolled and divided into two groups and supraclavicular brachial plexus block was performed by lateral approach using 30 ml of 0.5% levobupivacaine and 0.75% ropivacaine. The onset of sensory and motor block, duration of sensory and motor block and analgesia and possible adverse events were recorded.Results: No statistically significant difference was observed in the onset of sensory block in both groups. Onset of motor block was significantly faster in levobupivacaine group (P<0.05). Duration of sensory block, motor block and analgesia was significantly longer in levobupivacaine group (P<0.05).Conclusions: 0.5% levobupivacaine is better alternative to 0.75% ropivacaine in brachial plexus block in term of early onset of sensory block and long duration of analgesia.

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Efficacy and Safety of Fentanyl as An Adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v17i2.39774 ◽

2019 ◽

Vol 17 (2) ◽

pp. 31-35

Author(s):

Sanjida Hasan ◽

Ahmed Abu Nasar Chowdhury ◽

Syeda Nafisa Khatoon ◽

Md Harun OR Rashid ◽

Md Rezaul Hoque Tipu ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Efficacy And Safety ◽

College Hospital ◽

Analgesic Effects ◽

Upper Limb Surgery ◽

Supraclavicular Brachial Plexus Block ◽

Supraclavicular Block ◽

Plexus Block

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block. Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml). Results: The mean onset of sensory & motor block was 10.49±0.75 min & 9.41±0.76 min in group-C and 7.60±3.711min & 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs. Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35

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A Prospective Study of Dexmedetomidine as an Adjuvant to Local Anaesthetic Used in Supraclavicular Block

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/67 ◽

2021 ◽

Vol 8 (07) ◽

pp. 345-349

Author(s):

Paidikondala L.R.N.N. ◽

Kommula Gopala Krishna ◽

Subhamani P ◽

Sudhir Sirkar P

Keyword(s):

Brachial Plexus ◽

Local Anaesthetic ◽

Motor Block ◽

Brachial Plexus Block ◽

Sensory Block ◽

Postoperative Pain Management ◽

Control Group ◽

Rescue Analgesia ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

BACKGROUND To improve the quality of block (sensory and motor characteristics), postoperative pain management and reduce large doses of local anaesthetics, various adjuvants are used with local anaesthetic agents. We have evaluated dexmedetomidine as an adjuvant to 0.5 % ropivacaine in supraclavicular brachial plexus block in terms of onset and duration of sensory and motor block & duration of postoperative analgesia. METHODS This is a prospective randomised comparative study. 60 patients who were admitted for elective surgeries of the lower arm, at the level of elbow, forearm & hand were enrolled. They were divided in to two groups of 30 patients each as follows - group RD: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL (100 μg) of dexmedetomidine. Group RC: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL of normal saline. Various parameters like onset times and durations of sensory and motor block, duration of analgesia, total analgesic needed, and side-effects were recorded for each patient. RESULTS The time of onset of sensory and motor block was significantly early in dexmedetomidine group than in control group. The duration of sensory and motor block was significantly prolonged in group RD as compared to group RC. The duration of sensory block was 724.18 + 73.26 min in group RD (GD) and 582.16 + 93.12 min. in group RC (GC). The duration of analgesia was significantly prolonged in group RD. CONCLUSIONS Addition of dexmedetomidine as an adjuvant to ropivacaine is associated with early onset of sensory and motor block. The duration of sensory and motor block was prolonged. The duration of analgesia was prolonged and patients required less rescue analgesia. The use of dexmedetomidine was associated with reversible bradycardia and sedation score was less KEYWORDS Ropivacaine, Dexmedetomidine, Adjuvant, Supraclavicular Brachial Plexus Block

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A Prospective Randomised Controlled Double-Blinded Comparative Study of Plain Bupivacaine versus Bupivacaine and Dexamethasone for Supraclavicular Brachial Plexus Block, Government General Hospital, Nizamabad

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/194 ◽

2021 ◽

Vol 8 (16) ◽

pp. 1003-1008

Author(s):

Chintala Kishan ◽

Ravi Kiran Kumar G ◽

Inugurthy Sridhar ◽

Kiran Madhala

Keyword(s):

Blood Pressure ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Sensory Block ◽

Single Shot ◽

Upper Limb Surgery ◽

Significant Difference ◽

The Mean ◽

Double Blinded ◽

Plexus Block

BACKGROUND Dexamethasone (DES) is a very potent anti-inflammatory and analgesic glucocorticoid with very strong activity. The current study is randomised to determine the onset time, duration, and analgesic potency of bupivacaine (BUC) 0.5 percent, relative to BUC 0.5 percent and DES 8 mg by supraclavicular approach for brachial plexus block. METHODS In patients posted for upper limb surgery under a supraclavicular block, a prospective, randomised, double-blinded study was conducted. 60 Class I and II American Society of Anesthesiologists (ASA) patients were randomly divided into two classes. Group A received 0.5 percent of 30 ml BUS and group B received 0.5 percent of 28 ml BUS and 8 mg of 2 ml DES combined. For a single shot blockade of the supraclavicular brachial plexus, 30 ml of a solution was required. RESULTS The mean age of patients who received BUS was 36.9 ± 10.4 years and those who received BUS + DES was 34.7 ± 7.1 years (P = 0.328), there was no statistically significant difference between the mean ages of two groups (P > 0.05). The mean time of onset of sensory block in the BUS group was 8.6 ± 1.2 minutes and 5.6 ± 0.7 minutes in the BUS + DES group. There was a statistically significant difference between the onset of motor block in minutes among BUS and BUS + DES groups, there was a statistically significant difference between the mean ages of the two groups (P < 0.001). There was no statistically meaningful difference between the BUS and BUS + DES classes at various time intervals in the mean heart rate, difference in systolic blood pressure and diastolic blood pressure, and oxygen saturation. CONCLUSIONS The start of sensory and motor blockade also prolongs the length of DES 8 mg to BUS 0.5 percent speeds, thereby supplying improved analgesia and reducing the rescue analgesic requirements. KEYWORDS Bupivacaine, Dexamethasone, Brachial Plexus, Supraclavicular, Sensory Block

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A CLINICAL COMPARISON OF 0.75% ISOBARIC ROPIVACAINE WITH 0.5% ISOBARIC BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

10.36106/paripex/1201660 ◽

2020 ◽

pp. 43-46

Author(s):

Kalyan Sarma ◽

Bandana Mahanta ◽

Prabir Pranjal Das

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Motor Block ◽

Brachial Plexus Block ◽

Sensory Block ◽

Motor Blockade ◽

Supraclavicular Brachial Plexus Block ◽

The Mean ◽

Group B ◽

Plexus Block

Background: Regional anaesthesia and analgesia, has the potential to provide excellent operating conditions along with better and prolonged post-operative with pain relief with fewer side effects. As a result, it is becoming increasingly popular for ambulatory anaesthesia and for day care patients.. Among the commonly used local anaesthetics, lignocaine and bupivacaine, bupivacaine has significant cardiovascular and central nervous system toxicity. In addition, bupivacaine also has lesser differentiation between sensory and motor blockade post-operatively. Ropivacaine and levobupivacaine were developed to avoid the bupivacaine related toxicities. The clinical safety profile of ropivacaine seems to be more favourable than that of levobupivacaine. With this background the following study was conducted to evaluate the efficacy of ropivacaine 0.75% for brachial plexus block in upper limb surgeries and its clinical comparison with bupivacaine 0.5%. Aims and Objectives: To assess the efficacy and toxicity of ropivacaine 0.75% and bupivacaine 0.5% as potential agents for brachial plexus block for surgeries of the upper limb around and below the elbow. Settings and Design: prospective, comparative, randomized, single blinded clinical trial. Materials and Methods: After institutional ethical committee approval, 100 patients physical status ASA I & II, of either sex, between 18-60 years, weighing between 40-60 kgs posted for upper limb surgeries around the elbow, forearm and hand were divide into two groups of 50 patients each. Group R (Ropivacaine group) received 0.75% isobaric ropivacaine 30 ml in supraclavicular brachial plexus block. Group B (Bupivacaine group) received 0.5% isobaric bupivacaine 30 ml in supraclavicular brachial plexus block by using peripheral nerve stimulator. Vitals, sensory, motor and analgesia score at pre-defined intervals intra-operatively were noted. Onset of analgesia, sensory & motor blockade, total duration of post-operative pain relief (VAS ≥ 5) and time of demand of first rescue analgesic were also noted along with any intra-operative complications, if any. Statistical Analysis: All the results were expressed as Mean ± SD. Statistical analysis was performed using Unpaired Student’s t-Test. Statistical significance was considered with a p value of ≤ 0.05. Results: Demographic profile and duration of surgery were comparable among the two groups. The mean time of onset of sensory block, onset of motor block and onset of analgesia were significant (p<0.05) in group R as compared to group B. The mean duration of sensory block and duration of post-operative analgesia were comparable between the two groups. However, the mean duration of motor block was significantly lower (p<0.05) in group R as compared to group B. the baseline hemodynamic variables and requirement of first analgesic dose and other adverse events were equivalent in both the group. Conclusion: Ropivacaine when compared with Bupivacaine, has faster onset of analgesia, sensory & motor blockade, significantly lesser duration of motor blockade. Ropivacaine also provides satisfactory post-operative analgesia with a stable hemodynamic profile similar to Bupivacaine with no undue adverse effects.

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A Prospective Randomized Study to compare Levobupivacaine and Ropivacaine in Patients Undergoing Forearm Orthopaedic Surgeries under Ultrasound-Guided Supraclavicular Brachial Plexus Block

10.53350/pjmhs211572075 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2075-2081

Author(s):

Wasim Khursheed Mir ◽

Vipin Kumar Varshney ◽

Md Shahbaz Alam ◽

Prateek Singh ◽

G.S. Jheetay ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Randomized Study ◽

Prospective Randomized Study ◽

Ultrasound Guided ◽

Onset Of Action ◽

Significant Difference ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

Background: Brachial plexus block utilizing ultrasound imaging has now become either adjuvant to general anaesthesia (GA) or as a mainstay anaesthesia modality. There are fewer studies comparing the effects of ropivacaine and levobupivacaine for supraclavicular brachial plexus block. The aim of this study was to do a prospective randomized study to compare 0.5% Levobupivacaine and 0.5% Ropivacaine in patients undergoing forearm orthopaedic surgeries under Ultrasound-Guided Supraclavicular Brachial Plexus Block. Materials and Methods: A total of 56 patients were enrolled and randomized into two groups. Group R with 28 patients was given 30mL of 0.5% Ropivacaine and Group L with 28 patients were given 30 mL of 0.5% Levobupivacaine, drugs were used for giving supraclavicular block under ultrasound. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia, and any adverse events. After administration of block, the block characteristics were assessed every 5mins till the onset of the complete blockade, then hourly till the effect of the block. Data between the groups were analysed using SPSS 25.0 software. Results: Demographically both the groups were comparable in the study. The study shows that there was a statistically significant difference in onset of sensory block in Levobupivacaine and Ropivacaine (7.54 mins ± 2.10 vs 8.55 mins ± 2.08), similarly there was the difference in onset of motor block in Levobupivacaine 12.95 mins ± 2.30 vs Ropivacaine 14.07 mins ± 2.22. The duration of analgesia was more in the group of patients Levobupivacaine (9.98 hours ± 4.88) Ropivacaine (8.03 hours ± 3.58) Conclusion: the onset of action of sensory and motor was early in Levobupivacaine group with faster recovery of motor function as compared to the equivalent dose of Ropivacaine. Levobupivacaine has a better profile in terms of duration of analgesia. Keywords: Brachial plexus block, ropivacaine, levobupivacaine, supraclavicular brachial plexus block, ultrasound guidance

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Effect of Dexamethasone on The Duration of Analgesia for Supraclavicular Brachial Plexus Block

KYAMC Journal ◽

10.3329/kyamcj.v11i4.51997 ◽

2021 ◽

Vol 11 (4) ◽

pp. 199-203

Author(s):

Md Rafiqul Islam ◽

Laila Yesmin ◽

Md Pervez Rahman ◽

ABM Shafiul Anam Khan ◽

Md Miraj Hossain ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Onset Time ◽

Double Blind Study ◽

Double Blind ◽

Significant Difference ◽

Supraclavicular Brachial Plexus Block ◽

Group B ◽

Plexus Block

Background: Brachial plexus block with Bupivacaine provides effective intraoperative anesthesia and analgesia. The use of dexamethasone along with local anesthetic has been shown to improve the duration of analgesia. Objective: To observe the effect of Dexamethasone on the duration of analgesia for Supraclavicular Brachial plexus block. Materials and Methods: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. patients were randomly divided into two groups, Group (BD) and B. Group B received 28 ml of 0.25% bupivacaine with 2 ml normal saline while Group BD received 28 ml of 0.25% bupivacain with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade. All the information was recorded in data collection sheet. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Results: There was no significant difference between groups in respect of demographic and American Society of Anaesthesiologist (ASA) status. Mean age was found to 34.7±8.53 years. In Group (BD) , 63.3% were ASA I and 36.6% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory anaesthesia can be made possible by addition of adjuvant to local anaesthetic in brachial plexus block (in Group-BD). onset of sensory block was faster in Group BD (8.17 ± 1.4 min) than Group B (9.12 ± 1.68 min). Similarly mean onset time of motor block in group A was 12.26 ± 3.96 min, and 11.58 ± 3.68 min in group B. Our study shows that duration of motor block was 408.68±26.96 min and 380.26 ± 24.11 min in group BD and Group B respectively. Conclusion: There was significantly prolonged duration of analgesia in addition of Dexamethasone without any unwanted effects. KYAMC Journal Vol. 11, No.-4, January 2021, Page 199-203

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A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.033 ◽

2021 ◽

Vol 8 (2) ◽

pp. 155-160

Author(s):

Shabeel Aboobacker C P ◽

Shamjith K ◽

Melbin Baby ◽

Salman Mohammed Kutty C

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Motor Block ◽

Brachial Plexus Block ◽

Tertiary Care ◽

Random Allocation ◽

Duration Of Action ◽

Upper Limb Surgery ◽

Significant Difference ◽

Plexus Block

Brachial plexus block is one of the best surgical technique for upper limb surgeries. It is a good anesthetic and analgesic agent. Though levobupivacaine has a duration of action of three to eight hours it has an acceptable analgesic property and few other practical constraints. Addition of vasoconstrictors like α-adrenergic agonists, hyaluronidase, neostigmine, opioids have been found to be effective. Dexmedetomidine, an α2 receptor agonist has found to be a better adjuvant to levobupivacaine by few literatures. To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 μg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score.This study was conducted after ethical committee clearance in a tertiary care medical college hospital in northern Kerala, India. 60 patients between the age of 18 and 60 years planned for upper limb surgery under brachial plexus block, who fulfilled the inclusion and exclusion criteria were included in the study. A pre anesthetic checkup was done to assess the patient before including in the study. The patients who were included in the study were randomly assigned into two groups – one group received 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine(LD group) and the second group received 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine(LS group) as anesthetic agent through sealed envelope technique. The clinical history, vitals and hemodynamic parameters were monitored and noted prior to and during the surgery. The data collected was analyzed and tabulated. There was no statistically significant difference between both groups with respect to age, Gender and weight signifying proper random allocation of study subjects. None in LD group required post operative analgesia. The mean duration of onset of sensory and motor block was earlier and duration of motor and sensory analgesia was prolonged with the addition of Dexmedetomidine to Levobupivacaine. The hemodynamic stability was better with Dexmedetomidine. Bradycardia was reported in 20% of study participants who were administered dexmedetomidine Dexmedetomidine added to levobupivacaine provides better anesthetic and analgesic care in upper limb surgeries done using brachial plexus block.

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Addition of clonidine or fentanyl with bupivacaine for supraclavicular brachial plexus blocks in upper limb surgery - a randomized comparative study

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v24i1.19792 ◽

2014 ◽

Vol 24 (1) ◽

pp. 3-7

Author(s):

Nasir Uddin Ahmed ◽

Mozaffor Hossain ◽

AKM Akhtaruzzaman ◽

Montosh Kumar Mondol ◽

UH Shahera Khatun

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Sensory Block ◽

Control Group ◽

Upper Limb Surgery ◽

Supraclavicular Brachial Plexus Block ◽

Group A ◽

Group B ◽

Plexus Block

Background The popularity of supraclavicular brachial plexus block in upper limb surgery in recent years are due to better understanding of using adjuvant to local anaesthetics, its advantages and in avoidance of the hazards of general anaesthesia. Objective To compare the quality of anaesthesia and duration of analgesia with clonidine-bupivacaine or fentanyl-bupivacaine in supraclavicular brachial plexus block. Method A total number of 60 patients (ASA class 1 and II) were selected randomly into two groups, thirty in each group. Group-A (control group) received fentanyl (100ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.Group-B (study group) received clonidine (150ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.The parameters including pulse rate, non-invasive systolic and diastolic blood pressure, respiratory rate, SpO2, onset and duration of motor and sensory block, post operative pain score in VAS, duration of analgesia, first analgesic demand, side effects were assessed and recorded. Result Onset and duration of sensory block were significantly higher in group-B than in group-A (P<0.001) and motor block were quite prolonged in group-B than group-A (p<0.001), prevalence of sedation in group-B slightly higher than group-A. But intensity of pain measured by VAS in group-A expressed highest at 8 hours of postoperative period and group-B shows highest VAS at 12 hours. Duration of effective analgesia (time from supraclavicular block to first analgesic demand) in study group-B had significantly longer mean duration than that produced by control group-A (14.4 ± 1.3 vs 10.9 ± 1.5 hours; P<0.001). Conclusion Clonidine and bupivacaine combination is a better alternative to fentanyl and bupivacaine in respect of quality of anaesthesia and duration of analgesia. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19792 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 3-7

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A Comparative Clinical Evaluation of Efficacy of Tramadol As An Adjuvant To Bupivacaine En Brachial Plexus Block For Upper Limb Surgery

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v13i2.16535 ◽

2017 ◽

Vol 13 (2) ◽

pp. 13-16 ◽

Cited By ~ 1

Author(s):

Nabin Kumar Regmi ◽

Sangeeta Subba ◽

Uttam Chandra Sharma

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Nerve Blocks ◽

Group I ◽

Upper Limb Surgery ◽

Significant Difference ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

Background: In peripheral nerve blocks, adjuvants are added to local anaesthetics to improve the quality of anaesthesia and analgesia. We designed this randomized single blinded prospective study to compare the analgesic efficacy of tramadol used as an adjuvant to bupivacaine for supraclavicular brachial plexus block in patients undergoing orthopaedic surgeries of upper limb.Aim of study: In this study, we aimed to compare onset, duration and quality of analgesia along with respiratory, hemodynamic changes with tramadol as adjuvant to bupivacaine in supraclavicular brachial plexus block in the patients undergoing upper limb surgery.Method: In this prospective randomized control trial, two groups of 30 patients each were investigated. 28 ml. of 0.5% bupivacaine (plain) with 2 ml. normal saline was administered in group - I and 28 ml. of 0.5% bupivacaine (plain) with 2ml. (100 mg.) tramadol was administered in group - II. The onset of sensory and motor block, duration of analgesia, respiratory/hemodynamic parameters and post-operatively quality of analgesia via visual analogue scale were assessed.Results: The duration and quality of analgesia was significantly increased by adding tramadol in bupivacaine than bupivacaine alone (p=<0.001 and <0.001) whereas there was no statistically significant difference in onset of motor (p=>0.35) and sensory block (p=>0.75) and also hemodynamic and respiratory parameters.(HR p=>0.1, MAP p=>0.5, and SPO p=>0.5).Conclusion: The study suggests that tramadol when added to bupivacaine 2 for supraclavicular brachial plexus block enhances the quality of anaesthesia and analgesia without affecting respiratory/hemodynamic parameters.JNGMC Vol. 13 No. 2 December 2015, Page: 13-16

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A Comparative Study Between Two Different Doses of Dexmedetomidine Combined with Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v14i3.20908 ◽

2018 ◽

Vol 14 (3) ◽

pp. 127-131

Author(s):

Jeevan Singh ◽

Samir Shakya ◽

Anuranjan Ghimire ◽

Sanjay Saha ◽

Parikshit Bikram Singh

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Onset Time ◽

P Value ◽

Double Blind ◽

Significant Difference ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block ◽

Different Doses

Background: Though, various studies have been conducted to show the efficacy of dexmedetomidine as an adjuvant to brachial plexus block, there is no clear consensus for its optimal dose. We compared 2 different doses of dexmedetomidine (1mcg/kg Vs 2mcg/kg) with ropivaciane in USG guided brachial plexus block for the quality of anesthesia and analgesia. Materials and Methods: Fifty patients (18-50years, 50-60kgs), ASA PS I and II undergoing surgery of upper limb were enrolled in this prospective, double blind, randomized control trial. Group Rd received 19ml of 0.5% Ropivaciane with 1mcg/kg of dexmedetomidine (total 20ml), and Group RD received 19ml of 0.5% Ropivacaine with 2mcg/kg of dexmedetomidine (total 20ml). Onset and duration of sensory and motor block, duration of analgesia, sedation score, hemodyanamic changes were compared. We also monitored for various un towards effects. Results: The onset time of sensory and motor block (9.36±1.114 mins and 14.40 ± 1.528 mins in group Rd vs 8.32 ±0.945 mins and 12.40 ± 1.21 mins in group RD) were not significantly different between two groups (p-value > 0.05).The duration of sensory and motor block (596.20 ± 76.859 mins and 541.20±81.564 mins in group Rd vs 730.80 + 65.187 mins and 659.80±93.607 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). The duration of analgesia (626.00±70.475 mins in group Rd vs 754.00±60.139 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). Hemodynamic parameters were also comparable between two groups (p-value >0.05) but 3 patients in RD group (2mcg/kg) developed bradycardia and required treatment with atropine whereas in Rd group (1mcg/kg) none developed bradycardia. Conclusions: There is no significant difference in the onset and duration of block between the two groups. However, higher dose of dexmedetomidine is associated bradycardia. Hence, in comparision with 2mcg/kg, 1mcg/kg of dexmedetomidine is better adjuvant to 0.5% ropivaciane in terms of safety and effectiveness.Keywords: dexmedetomidine; ropivacaine; supraclavicular brachial plexus block.

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