Abstract
Background and Aims: The aim of this study was to find out the effect of Dexmedetomidine used as an adjuvant with Ropivacaine in Supraclavicular brachial plexus block in upper limb surgeries.
Materials and Methods: 80 patients undergoing elective upper limb surgeries under Supraclavicular brachial plexus block and belonging to American society of Anesthesiologists Grade I or II were divided into 2 groups of 40 patients each. Group A (n=40) received 30 ml 0.5% Ropivacaine and 1 ml normal saline and Group D (n=40) received 30 ml 0.5% Ropivacaine and 1 μg/kg of Dexmedetomidine. The primary outcome was evaluated in term of duration of analgesia. Other outcomes which were evaluated included time of onset and duration of sensory and motor blockade, degree of analgesia and sedation, vital parameters during and in immediate postoperative period.
Results: Demographic profile and mean duration of surgery was similar in both the groups. Onset of sensory and motor blockade was found to be earlier in Group D than in Group A. The duration of sensory and motor block was statistically significantly prolonged in group D than in group A. Duration of analgesia and degree of sedation was also higher in group D than in group A. The incidence of bradycardia was more in group D than in Group A. Other vital parameters like mean arterial pressure and SPO2 were comparable in both the groups.
Conclusion: Addition of dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial Plexus block in upper limb surgeries is associated with prolonged postoperative analgesia, better sedation and shortened time for onset of sensory and motor block. It is associated with statistically significant prolonged duration of brachial plexus block in comparison with use of ropivacaine alone. Use of dexmedetomidine is found to be associated with increased incidence of bradycardia.
Keywords: Dexmedetomidine, Ropivacaine, Supraclavicular brachial plexus block, Bradycardia, Analgesia and Sedation.
References
- Smigovec E, Tripković B, Sulentić M, Smigovec I, Milavec D, Bukvić Mokos Z. Regional anesthesia for upper extremity surgery--our experience. Acta Dermatovenerol Croat. 2008;16(1):8-12.
- Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. 2015 Sep 11; (9):CD006459.
- Jakobsson J, Johnson MZ. Perioperative regional anaesthesia and postoperative longer-term outcomes. F1000Research. 2016;5:F1000 Faculty Rev-2501.
- Agarwal A, Kishore K. Complications And Controversies Of Regional Anaesthesia: A Review. Indian Journal of Anaesthesia. 2009;53(5):543-553.
- Ali QE, Manjunatha L, Amir SH, Jamil S, Quadir A. Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study. Indian Journal of Anaesthesia. 2014;58(6):709-713.
- Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Hanaoka. K, ed. Medicine. 2017;96(4):e5846.
- Markham A, Faulds D. Ropivacaine : A Review of its Pharmacology and Therapeutic Use in Regional Anaesthesia. Drugs. 1996 Sep;52(3):429-449.
- Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesthesia, Essays and Researches. 2014;8(2):202-208.
- Hansen TG. Ropivacaine: a pharmacological review. Expert Rev Neurother. 2004 Sep;4(5):781-91
- Rukewe A, Fatiregun A, Alonge TO. Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital. Malawi Medical Journal. 2014;26(3):90-92.
- Zhang Y, Wang CS, Shi JH, Sun B, Liu SJ, Li P, Li EY. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block. Int J Clin Exp Med. 2014 Mar 15;7(3):680-5.
- Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013 Mar;110(3):438-42.
- Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi Journal of Anaesthesia. 2015;9(2):148-154.
- Chinnappa J, Shivanna S, Pujari VS, Anandaswamy TC. Efficacy of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block for upper limb surgeries. Journal of Anaesthesiology, Clinical Pharmacology. 2017;33(1):81-85.
- Channabasappa SM, Shetty VR, Dharmappa SK, Sarma J. Efficacy and safety of dexmedetomidine as an additive to local anesthetics in peribulbar block for cataract surgery. Anesthesia, Essays and Researches. 2013;7(1):39-43.
Corresponding Author
Dr Jayant Prakashrao Shinde
Senior Resident, Department of Anesthesiology,
Dr Shankarrao Chavan Government Medical College, Nanded (MS)- India
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.116
