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Category: Volume 08 Issue 02 February 2020
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Title: Comparative Study between Fentanyl and Dexmedetomidine as Adjuvant to Ropivacaine in Brachial Plexus Block

Authors: Dr D.B.V. Madhusudhanarao, Dr Kadiri Srujana

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.141

Abstract

   

Background:  Supraclavicular brachial plexus block is a frequently performed procedure to provide anesthesia and postoperative analgesia for upper limb surgeries.  Bupivacaine is the most commonly used anesthetic, but ropivacaine has been successfully used as it is less cardiotoxic, less arrhythmogenic. Adjuvants to local anesthetics enhance the quality and duration of analgesia.

Aim: To compare the effects of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block.

Materials & Method: After informed consent, sixty ASA I and II patients scheduled for upper limb surgeries under supraclavicular block randomly allocated into two groups of 30 each. GROUP D received 30ml of 0.5% ropivacaine with 20 µg dexmedetomidine and GROUP F received 30ml of 0.5% ropivacaine with 50µg fentanyl. Onset and duration of sensory and motor block, duration of analgesia were compared.

Results:  Demographic variables were comparable between the two groups. The onset of sensory block in group F is 9.1 ± 1.84 min, and group D is7.56 ± 1.81 min(<0.0019). The onset of motor block in group F is 15.6 ± 2.65 min and group D is 11.7 ± 2.28 min(<0.0001). Duration of sensory in group F and group D is 509.4 ± 45.43 min and 683.83 ± 96.96 min respectively(<0.0001). Duration of motor block in group F and group D is 457.6 ± 43.58 min and 618.7 ± 100.7 min respectively(<0.0001). Duration of analgesia in group F is596.9 ± 59.5 min and group D is770.66 ± 110.19 min(<0.0001). Significant difference observed in duration of sensory, motor block, and analgesia between the two groups.

Conclusion: Dexmedetomidine is better adjuvant to ropivacaine than fentanyl as it enhances the duration of block and analgesia without adverse hemodynamic consequences.

References

  1. Khanduri KC. Regional anesthetic techniques for orthopaedic surgeries. Med J Armed Forces Indian 2008; 64:109
  2. Dixit R, Chakole V et all, Effect of buprenorphine on post operative analgesia in supraclavicular brachial plexus block using peripheral nerve locater. Journal of evolution of medical and dental science; volume 2 /issue 2 /2013:113-17
  3. De Negri P, Ivani G, Tirri T, Del Piano AC. New local anesthetics for pediatric anesthesia. Curr Opin Anaesthesiol 2005; 18:289‑
  4. Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy. Br J Anaesth 2001; 86:77‑
  5. Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011;55:352-7.
  6. Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyper polarization-activated cation current. Anesthesiology 2011;115:836-43.
  7. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anaesth Analg 2010;111:1548-51.
  8. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to Bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol 2010;27:280-4.
  9. Chavan SG, Koshire AR, Panbude P. Effect of addition of fentanyl to local anesthetic in brachial plexus block on duration of analgesia. Anesth Essays Res 2011;5:39-42.
  10. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013;110(6):915–25. 10
  11. Cousins MJ Bridenbaugh. Neural blockade in clinical anaesthesia and pain medicine. 4th ed.: Lippincott Williams and Wilkins; 2009
  12. Edward G Morgan, Maged S Mikhail, Micheal J Murray. Peripheral nerve blocks,4th ed. Chapter 17. In: Clinical anaesthesiology, New Delhi: Tata McGraw-Hill; 2009.
  13. Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: a review of its use in regional anaesthesia and acute pain management. 2005;65:2675–717. doi: 10.2165/00003495-200565180-00013. 
  14. Sindjelic RP, Vlajkovic GP, Davidovic LB, Markovic DZ, Markovic MD. The addition of fentanyl to local anaesthetics affects the quality and duration cervical plexus block: A randomized controlled trial. Anaesth Analg. 2010;111:234–7. doi: 10.1213/ANE.0b013e3181e1e9ab. 
  15. Karakaya D, Büyükgöz F, Bariş S, Güldoğuş F, Tür A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med. 2001;26:434–8. doi: 10.1053/rapm.2001.24675.
  16. Chakraborty S, Chakrabarti J, Mandal MC, Hazra A, Das S. Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial. Indian J Pharmacol. 2010;42:74–7
  17. Geze S,  Ulusoy  H,  Ertürk  E,  Cekic  B,  Arduc    Comparison  of  local anaesthetic mixtures of tramadol or fentanyl for axillary plexus block in orthopaedic upper limb surgery. Eur J Gen Med 2012;9(2):118-23
  18. Madhusudan R,  Kumar  K,  Kumar  R,  Potli  S,  Karthik  D,  Kapil    Supraclavicular brachial plexus block with 0.75% ropivacaine and with additives tramadol, fentanyl – A comparative pilot study. Int J Biol Med Res 2011;2(4):1061-3
  19. Nishikawa K,  Kanaya  N,  Nakayama  M,  Igarashi  M,  Tsunoda  K,  Namiki    Fentanyl improves  analgesia  but  prolongs  the  onset  of  axillary brachial plexus block by peripheral mechanism. Anesth Analg 2000;91(2):384-7.
  20. 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; 110: 438-42.
  21. Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2014;30(1):36-40.
  22. Dharmarao PS, Holyachi R. Comparitive study of efficacy of dexmeditomidine and fentanyl as adjuvants to ropivacaine I usg guided block.Turk J Anesthesiol Reanim2018;46;208-13
  23. Hamed MA, Ghaber S, Reda A. Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block:A randomized controlled study. Anesth Essays Res 2018:12:475-9.

Corresponding Author

Dr Kadiri Srujana

Postgraduate, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, AP