Title: Effect of Addition of Dexmedetomidine as an Adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block
Authors: Dr Aneesh K V, Dr Rajani Gandhi
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.55
Abstract
INTRODUCTION
Brachial plexus nerve blocks have become important in clinical practice because of their role in post-operative pain relief1, shortening of patient recovery time and avoiding risks and adverse effects of General anaesthesia2,3. Hence,peripheral nerve blockade is now a well-accepted concept for comprehensive anesthetic care. In 1928, Kulenka-mpff and Persky published their experiences with a thousand blocks without apparent major complications3. The subclavian (Supraclavicular) perivascular technique was first developed by Alon Willie and Collins4. The advantage of Supra clavicular technique over other brachial plexus approaches are its rapid onset and complete predictable anesthesia. Levobupivacaine is a high potent ,long acting amide local anaesthetic, with less cardio toxic effects5. Levobupivacaine is a local anesthetic with long duration, having similar pharmacology to bupivacaine; however, it has a wider safety margin and was shown to possess less cardio toxicity in comparison with bupivacaine6,7. So it has been one of the most commonly used local anesthetic for peripheral nerve blocks. Dexmedetomidine is a pharmacolo-gically active dextro isomer of Medetomidine; a selective α2-adrenergic receptor agonist which provides analgesia and sedation8, it provides more hemodynamic stability intense analgesia with less respiratory depression and rapid recovery8,9,10. Numerous studies has shown that the use of local anesthetic agents with adjuvants such as clonidine16 and tramadol for a brachial plexus block to improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may prolong anesthesia and analgesia. Hence here is an attem pt to study the Effect of addition of Dexmedetomidine to Levobupivacaine in supraclavicular brachial plexus block alone for supraclavicular brachial plexus block in prolonging the duration of analgesia in patients undergoing orthopedic surgery of forearm or hand. In this study, we investigated the effects of adding dexmedeto-midine to Levobupivacaine in supraclavicular brachial plexus block. The primary outcome of our study was the duration of analgesia, and the secondary outcome were duration and onset of sensory and motor block and side effects.
