EFFECT OF PERINEURAL ADMINISTRATION OF DEXMEDETOMIDINE WITH BUPIVACAINE VERSUS BUPIVACAINE ALONE IN ULTRASOUND GUIDED SUPRACLAVICULAR BLOCK FOR UPPER EXTREMITY ORTHOPAEDIC OPERATIONS
DOI:
https://doi.org/10.55519/JAMC-03-12044Abstract
Background: During procedures on the upper limbs, the brachial plexus block is usually advised. To increase the length of the block, many medicines have been utilized as adjuvants. The purpose of this study was to compare the effects of dexmedetomidine plus bupivacaine against bupivacaine alone on the onset and duration of the sensory and motor block and the duration of analgesia in the supraclavicular block during upper extremity orthopaedic surgery. Methods: Sixty individuals qualified for orthopaedic operations on the upper extremities, ranging in age from 20 to 60 years, participated in this prospective, randomized investigation. The modified Bromage scale and the pinprick method were used to assess the sensory and motor block. Using a visual analogue pain scale, the postoperative pain was evaluated at 0, 6, 12 and 24 hours after surgery. Results: In patients receiving only bupivacaine, the mean onset time of sensory and motor block was 32.84 minutes and 26.67 minutes respectively; while in those receiving bupivacaine along with dexmedetomidine, it was 23.38 minutes and 14.81 minutes (p<0.005). In the intervention group (bupivacaine and dexmedetomidine), the period between the first request for analgesia and the duration period of sensory and motor block were both longer (p<0.005). The intervention group experienced less postoperative discomfort for 24 hours (p<0.05). Conclusion: Dexmedetomidine added to bupivacaine perineurally prolonged both numbness and immobility while shortening the time it took for sensory and motor blocks to begin. Moreover, dexmedetomidine considerably decreased postoperative pain when combined with bupivacaine for supraclavicular blocks.
References
Meco BC, Ozcelik M, Oztuna DG, Armangil M, Guclu CY, Turhan SC, et al. Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study, J Anesth 2015;29(2):217-22.
White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg 2007;104(6):1380-96.
Bhatia A, Lai J, Chan VW, Brull R. Case report: Pneumothorax as a complication of the ultrasound-guided supraclavicular approach for brachial plexus block. Anesth Analg 2010;111(3):817-9.
Rwei AY, Sherburne RT, Zurakowski D, Wang B, Kohane DS. Prolonged duration local anesthesia using liposomal bupivacaine combined with liposomal Dexamethasone and dexmedetomidine. Anesth Analg 2018;126(4):1170-5.
Kumar G, Dubey PK, Sanjeev OP. Effect of midazolam and dexmedetomidine sedation on the onset and duration of supraclavicular brachial plexus block: a randomised comparative study. Turk J Anesthesiol Reanim 2018;46(3):201-7.
Subramanya V, Kapinigowda ST, Math AT, Chennaiah VB. Dexmedetomidine as an adjuvant for intravenous regional anesthesia in upper limb surgeries. Anesth Essays Res 2017;11(3):661-4.
Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks. Medicine (Baltimore) 2017;96(4):e5846.
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet 2017;56(8):893-913.
Venn RM, Karol MD, Grounds RM. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care ' . Br J Anaesth 2002;88(5):669-75.
Singh AP, Mahindra M, Gupta R, Bajwa SJ. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: a novel anesthetic approach. Anesth Essays Res 2016;10(3):414-9.
Tripathi A, Sharma K, Somvanshi M, Samal RL. A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2016;32(3):344-8.
Swami S, Ladi S, Keniya V, Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: a randomised double-blind prospective study. Indian J Anaesth 2012;56(3):243-9.
Thakur A, Singh J, Kumar S, Rana S, Sood P, Verma V. Efficacy of dexmedetomidine in two different doses as an adjuvant to lignocaine in patients scheduled for surgeries under axillary block. J Clin Diagn Res 2017;11(4):UC16-21.
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.
Nazir N, Jain S. A randomized controlled trial study on the effect of adding dexmedetomidine to bupivacaine in supraclavicular block using ultrasound guidance. Ethiop J Health Sci 2016;26(6):561-6.
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(2):475-9.
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 2008;21(4):457-61.
Fan TWV, Ti LK, Islam I. Comparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index. Br J Oral Maxillofac Surg 2013;51(5):428-33.
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 hyperpolarization-activated cation current. Anesthesiology 2011;115(4):836-43.
Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res 2012;2(1):67-9.
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.
Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block. Anesth Analg 2015;121(6):1655-60.
Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015;9(2):148-54.
Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, et al. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone. Reg Anesth Pain Med 2014;39(1):37-47.
Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010;111(6):1548-51.
Kwon Y, Hwang SM, Lee JJ, Kim JH. The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block. Korean J Anesthesiol 2015;68(1):32-6.
Kaygusuz K, Kol IO, Duger C, Gursoy S. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block. Curr Ther Res Clin Exp 2012;73(3):103-11.
Wang K, Wang L, Yang T, Mao Q, Wang Z, Chen L. Dexmedetomidine combined with local anesthetics in thoracic paravertebral block. Medicine (Baltimore) 2018;97(46):e13164.
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