COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE VERSUS BUPIVACAINE WITH CLONIDINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

KALLURI SAIPRIYANKA; NAGAJYOTHI J

doi:10.22159/ajpcr.2024.v17i1.50323

Authors

KALLURI SAIPRIYANKA Department of Anesthesia, East Point College of Medical Sciences and Research Centre.Bengaluru, Karnataka, India
NAGAJYOTHI J Department of Anesthesia, East Point College of Medical Sciences and Research Centre.Bengaluru, Karnataka, India

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i1.50323

Keywords:

Dexmedetomidine, Clonidine, Brachial plexus block, Quality of anesthesia

Abstract

Objective: To compare the efficacy of clonidine with dexmedetomidine as an adjunct to bupivacaine in patients undergoing upper limb surgeries under supraclavicular brachial plexus block.

Methods: This was a prospective comparative study conducted in the department of anesthesiology of a tertiary care medical institute. 80 patients undergoing various upper-limb surgeries were included in this study. Patients were divided into two groups on the basis of whether they received Clonidine (Group C) or Dexmedetomidine (Group D) as an adjuvant to Bupivacaine for supraclavicular block. The onset as well as duration of sensory and motor blockade, duration of analgesia, quality of anesthesia, hemodynamics, and adverse effects were compared between the two groups. p<0.05 was considered statistically significant.

Results: The gender distribution of cases in Group C and Group D was found to be comparable, with no statistically significant difference. The mean age of patients in both groups was found to be comparable with no significant difference (p=0.5671). The most common types of surgeries in the studied cases were those of the lower radius and ulna (28.75%), followed by the lower humerus (21.25%), upper radius, and ulna (20%). The mean duration of sensory and motor block and duration of analgesia were found to be higher in group D as compared to group C, and the difference was found to be statistically highly significant (p<0.0001). The quality of anesthesia was better in patients who received dexmedetomidine as compared to those who received clonidine with Bupivacaine.

Conclusion: Dexmedetomidine used as an adjuvant with bupivacaine for brachial plexus block is associated with prolonged duration of sensory as well as motor block and duration of analgesia as compared to when clonidine is used as an adjuvant. It is also associated with a better quality of anesthesia.

Downloads

Download data is not yet available.

References

Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, et al. Upper extremity regional anaesthesia: Essentials of our current understanding, 2008 [published correction appears in Reg Anesth Pain Med. 2010 Jul-Aug;35(4):407]. Reg Anesth Pain Med 2009;34:134-70. doi:10.1097/AAP.0b013e31819624eb

D’Souza RS, Johnson RL. Supraclavicular block. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.

Omoregbe OR, Idehen HO, Imarengiaye CO. Supraclavicular brachial plexus block for upper limb fracture fixation: A comparison of nerve stimulation, ultrasound-guided technique and a combination of both techniques. West Afr J Med 2020;37:757-62.

Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anaesthesia of the brachial plexus. Anesth Analg 1994;78:507-13. doi:10.1213/00000539-199403000-00016

Aksu R, Bicer C. Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block. Clin Invest Med 2017;40:E111-6. doi:10.25011/cim.v40i3.28390

Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anaesthetics: Current understanding and future trends. World J Clin Cases 2017;5:307-23. doi:10.12998/wjcc.v5.i8.307

Popping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anaesthetics for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology 2009;111:406- 15. doi:10.1097/ALN.0b013e3181aae897

McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anaesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med 2007;32:330-8. doi:10.1016/j.rapm.2007.02.010

Singh AP, Mahindra M, Gupta R, Bajwa SJ. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anaesthetic approach. Anesth Essays Res 2016;10:414-9. doi:10.4103/0259-1162.176404

Kumari P, Singh RB, Saurabh K, Pal S, Ram GK, Anand RK. To compare the efficacy of postoperative analgesia between clonidine and dexmedetomidine as adjuvants with 0.5% ropivacaine by ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries: A prospective, double-blind, randomized study. Anesth Essays Res 2020;14:644-52. doi:10.4103/aer.aer_57_21

Schubert AK, Seneviratne V, Stolz J, Wiesmann T, Wulf H, Eberhart L, et al. The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia: A systematic review with network meta-analysis of randomised trials. Eur J Anaesthesiol 2023;40:672-90. doi:10.1097/EJA.0000000000001860

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;32:344-8. doi:10.4103/0970-9185.188819

Bajpai V, Patel TK, Dwivedi P, Bajpai A, Gupta A, Gangwar P, et al. Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: Ameta-analysis of randomised controlled trials. Braz J Anesthesiol 2023;73:665-75. doi:10.1016/j.bjane.2022.07.005

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. Anesthesiology 2008;109:502-11. doi:10.1097/ALN.0b013e318182c26b

Kataria AP, Jarewal V, Singh G, Attri JP. Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. Int J Med Res Rev 2017;5:399- 404. doi:10.17511/ijmrr.2017.i04.05

Chaudhary UK, Danesh A, Mahajan M, Kumar S, Verma V, Awasthi B. Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block. Int J Res Med Sci 2017;5:4512-8.

Ganga G, Amrutha K, Joseph T. Dexmedetomidine v/s clonidine as adjuvants to bupivacaine in supraclavicular brachial plexus block. Int J Health Sci 2022;6:944-95.

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: Arandomised double-blind prospective study. Indian J Anaesth 2012;56:243-9. doi:10.4103/0019-5049.98767

Sebastian D, Ravi M, Dinesh K, Somasekharam P. Comparision of dexmedetomidine and clonidine as adjuvant to ropivacaine in supraclavicular brachialplexus nerve blocks. J Dent Med Sci 2015;14:91-7. doi: 10.9790/0853-14359197

Rao KG, Kapoor P, Chaurasiya MK, Shukla A. A randomized double blind prospective study to compare coinidine and dexmedetomidine as an adjuvant in supra-clavicular brachial block. Indian J Fundam Appl Life Sci 2014;4:226-9.