Alpha 2 agonist dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block

  • Dr Vaishali Waindeskar Professor, Department of Anesthesiology, People’s College of Medical Sciences & Research Centre, Bhopal, India
  • Dr Abhilekh Jain Associate Professor, Department of Anesthesiology, People’s College of Medical Sciences & Research Centre, Bhopal, India
  • Dr Jitendra Kumar Assistant Professor, Department of Anesthesiology, People’s College of Medical Sciences & Research Centre, Bhopal, India
  • Dr Anupam Pandey Assistant Professor, Department of Anesthesiology, People’s College of Medical Sciences & Research Centre, Bhopal, India
  • Dr Sheetal Songir Associate Professor, Department of Anesthesiology, People’s College of Medical Sciences & Research Centre, Bhopal, India
DOI: https://doi.org/10.17511/ijmrr.2016.i05.33
Keywords: Adjuvant, Dexmetomidine, Supraclavicular brachial plexus block

Abstract

Background: Regional anesthesia is a recommended technique for upper limb surgeries with better postoperative profile. Alpha-2 agonists are added to local anesthetic agents to extend the duration of nerve blocks. We evaluated the effect of combining dexmedetomidine with bupivacaine with respect to duration of motor and sensory block and duration of analgesia.

Materials and Methods: Sixty patients posted for upper limb surgeries were enrolled for a prospective, randomized, study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% bupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325% bupivacaine +1μg/kg dexmedetomidine given ultrasound guided supraclavicular brachial plexus block.

Results: The onset times for sensory and motor blocks were significantly shorter in BD than B group (p < 0.05), while the duration of sensory and motor blocks was significantly longer in BD group. The duration of analgesia was significantly longer in BD group than B group (p < 0.0001). SBP and DBP levels in BD group were significantly lower than in B group 20 min after block (p < 0.001). Bradycardia was observed in two patients in the group BD.

Conclusion: Dexmedetomidine added as an adjuvant to bupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia. Patients in group BD were adequately sedated with no adverse effects except bradycardia in two patients.

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References

1. Singelyn FJ, Dangoisse M, Bartholomee S, Gouverneur JM. Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Regional Anesthesia and Pain Medicine. 1992 May 1;17(3):148-50.

2. Pöpping DM, Elia N, Marret E, Wenk M, Tramer MR. Clonidine as an Adjuvant to Local Anesthetics for Peripheral Nerve and Plexus BlocksA Meta-analysis of Randomized Trials. The Journal of the American Society of Anesthesiologists. 2009 Aug 1;111(2):406-15.

3. Virtanen R, Savola JM, Saano V, Nyman L. Characterisation of selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharmacol. Eur J Pharmacol. 1988 May 20;150(1-2):9-14.

4. Shehabi Y, Ruettimann U, Adamson H, Innes R, Ickeringill M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive care medicine. 2004 Dec 1;30(12):2188-96.

5. Abosedira MA. Adding clonidine or dexmedetomidine to lignocaine during Biers block: A comparative study. J Med Sci. 2008; 8:660–4

6. Mantz J, Singer M. Importance of patient orientation and rousability as components of intensive care unit sedation. In: Maze M, Morrison P, editors. Redefining Sedation. London, UK: The Royal Society of Medicine Press Ltd; 1998. pp. 23–9.

7. Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag. 2010 Jan 1;6(11):111-21.

8. 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.

9. 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. European Journal of Anaesthesiology (EJA). 2010 Mar 1;27(3):280-4.

10. Rancourt MP, Albert NT, Côté M, Létourneau DR, Bernard PM. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesthesia & Analgesia. 2012 Oct 1;115(4):958-62.

11. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. The Journal of the American Society of Anesthesiologists. 2008 Sep 1;109(3):502-11.

12. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an α-2A adrenoceptor. Anesthesia & Analgesia. 2008 Jul 1;107(1):96-101.

13. Memis D, Turan A, Karamanlioglu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lignocaine for IVRA. Anesth Analg. 2004; 98: 835–40.

14. Merle N Tandoc, Liang Fan, Sergei Kolesnikov, Alexander Kruglov, Nader D. Adjuvant dexamethasone with bupivacaine prolongs the duration of inter scalene block: a prospective randomized trial. Journal of Anesthesia October 2011, Volume 25, Issue 5, pp 704-709.

15. Amany S Ammar, Khaled M Mahmoud. 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 J Anaesth. 2012 Apr-Jun; 6(2): 109–114.

16. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. British journal of anaesthesia. 2009 Aug 1;103(2):268-74.

17. 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.

18. Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potentials in frog sciatic nerves without α2 adrenoceptor activation. British journal of pharmacology. 2010 Aug 1;160(7):1662-76.

19. Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag. 2010 Jan 1;6(11):111-21.

20. Yazbek-Karam VG, Aouad MM. Perioperative uses of dexmedetomidine. Middle East J Anesthesiol. 2006 Oct;18(6):1043-58.

21. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Current opinion in anaesthesiology. 2008 Aug 1;21(4):457.

22. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesthesia & Analgesia. 2000 Mar 1;90(3):699-705.
CITATION
DOI: 10.17511/ijmrr.2016.i05.33
Published: 2016-05-31
How to Cite
1.
Waindeskar V, Jain A, Kumar J, Pandey A, Songir S. Alpha 2 agonist dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Int J Med Res Rev [Internet]. 2016May31 [cited 2024Dec.23];4(5):855-60. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/568
Issue
Vol 4 No 5 (2016): MAY
Section
Original Article