02Jan 2019

EVALUATION OF DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BLOCK FOR PATIENTS UNDERGOING UPPER LIMB PLASTIC SURGICAL PROCEDURES.

  • Registrar Anesthesia, Government Dental College Srinagar, India.
  • Assistant Professor Plastic Surgery, KAAUH, Princess Nourah University, SA.
  • Demonstrator Anatomy, Government Medical College Srinagar, India.
  • Consultant Anesthesia, District Hospital Baramulla, India.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background:Different adjuvants are used with local anesthetics to improve quality of peripheral nerve blocks. The aim of our study was to evaluate the effect of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block with respect to onset of sensory and motor blockade and duration of blockade and analgesia. Patients and Methods: Sixty patients of ASA grade I and II, aged 18-55 years of either sex scheduled for upper limb plastic surgical procedures under supraclavicular brachial plexus block were randomly divided into two equal groups. Patients in control group R (n = 30) received 29 ml of 0.5% ropivacaine with 1ml normal saline (control) and in study group RD (n = 30) received 29 ml of 0.5% ropivacaine with 1 ml (50?g) dexmedetomidine. The onset and duration of sensory and motor block, duration of analgesia were analyzed in both the groups Results:The mean time of onset of sensory blockade were 5.1?0.91 min and 3.2?0.82 min respectively in group R and RD. Whereas time of onset of motor blockade were 11.21?1.81 min and 6.45?0.92 min respectively in group R and RD. The durations of sensory and motor block were 455.31 ? 19.31 and 365 ? 18.41 min respectively in group R, whereas they were 693 ? 11.01 and 656 ? 18.26 min respectively in group RD. The duration of analgesia was 481.31? 16.01 min in group R compared to 718.32 ? 11.25 min in group RD (p<0.001). Statistically significant difference was found between the two groups with respect to their onset and duration of sensory and motor blockade as well as in their total duration of analgesia. Conclusions: We conclude that in supraclavicular brachial plexus block addition of dexmedetomidine to ropivacaine shortens the onset of sensory and motor blockade and prolongs the total duration of sensory and motor block as well as total duration of analgesia.

  1. Bazin Je, Massoni C, Brulle P, Fenies V, Groslier D, Schoeffler P. The Addition Of Opoids To La In Brachial Plexus Blocks The Comparative Study Of Effect Of Morphine, Buprenorphine And Sufentanyl. Anaesthsia 1997; 52:858-862.
  2. Sadeghi SA, Soleimani AA, Soleimanifar M. Supplemental Pethidine and Fentanyl to local anesthetics in supraclavicular block. ActaMedicaIranica. 2003; 41(2):134-7.
  3. Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesthesia & Analgesia. 2000 May 1; 90(5):1122-8.
  4. Jarbo K, Batra YK, Nidhi M, Panda B. Brachial plexus block with midazolam and bupivacaine improves analgesia. Canadian Journal of Anesthesia. 2005 Oct 1; 52(8):822-6.
  5. Wakhlo R, Gupta V, Raina A, Gupta SD, Lahori VU. Supraclavicular plexus block: Effect of adding tramadol or butorphanol as an adjuncts to local anaesthetic on motor and sensory block and duration of post-operative analgesia. Journal of Anaesthesiology Clinical Pharmacology. 2009 Jan 1; 25(1):17.
  6. Iohom G, Machmachi A, Diarra DP, Khatouf M, Boileau S, Dap F, Boini S, Mertes PM, Bouaziz H. The effects of clonidine added to mepivacaine for paronychia surgery under axillary brachial plexus block. Anesthesia & Analgesia. 2005 Apr 1; 100(4):1179-83.
  7. Lalla RK, Anant S, Nanda HS. Verapamil as an adjunct to local anaesthetic for brachial plexus blocks. Medical Journal Armed Forces India. 2010 Jan 31; 66(1):22-4.
  8. ?kerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Actaanaesthesiologicascandinavica. 1988 Oct 1; 32(7):571-8.
  9. Reiz S, H?ggmark S, Johansson G, Nath S. Cardiotoxicity of ropivacaine?a new amide local anaesthetic agent. ActaAnaesthesiologicaScandinavica. 1989 Feb 1; 33(2):93-8.
  10. Kanazi GE, Aouad MT, Jabbour‐Khoury SI, Al Jazzar MD, Alameddine MM, Al‐Yaman R, Bulbul M, Baraka AS. Effect of low‐dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block.ActaAnaesthesiologicaScandinavica. 2006 Feb 1; 50(2):222-7.
  11. Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia.Current drug targets. 2009 Aug 1; 10(8):696-706.
  12. Kauppila T, Kemppainen P, Tanila H, Pertovaara A. Effect of systemic medetomidine, an alpha 2 adrenoceptor agonist, on experimental pain in humans. Anesthesiology. 1991 Jan; 74(1):3-8
  13. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, Willatts SM. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit.Anaesthesia. 1999 Dec 1; 54(12):1136-42.
  14. Peterson Kandall F, Kendall Mccreary E, EdsMuskeln : Function And Tests. New York: Gustav Fischer VerlagStuwartt 1988: 3-13.
  15. Crichton N. Visual analogue scale (VAS). J ClinNurs. 2001 Sep 1; 10(5):706-6.
  16. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesthesia & Analgesia. 2010 Dec 1; 111(6):1548-51.
  17. Ammar AS, Mahmoud KM. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi journal of anaesthesia. 2012 Apr 1; 6(2):109.
  18. Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. The Journal of the American Society of Anesthesiologists. 1996 Apr 1; 84(4):873-81.
  19. Swami SS, Keniya VM, Ladi SD, 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 journal of anaesthesia. 2012 May 1; 56(3):243.
  20. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block. Saudi Journal of Anaesthesia. 2015 Apr; 9(2):148-154.

[Summaira Jan, Tawheed Ahmad, Saima Rashid and Shabir Ahmad Langoo. (2019); EVALUATION OF DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BLOCK FOR PATIENTS UNDERGOING UPPER LIMB PLASTIC SURGICAL PROCEDURES. Int. J. of Adv. Res. 7 (Jan). 259-263] (ISSN 2320-5407). www.journalijar.com

Dr. Tawheed Ahmad
King Abdullah bin Abdulaziz University Hospital, Princess Nourah University

DOI:

Article DOI: 10.21474/IJAR01/8322      
DOI URL: https://dx.doi.org/10.21474/IJAR01/8322

Download Full Paper

Download PDF No. of Downloads: 14 | No. of Views: 104