Dexmedetomidine as an adjunct to bupivacaine and xylocaine with adrenaline in ultrasound guided supraclavicular brachial plexus block in upper limb surgeries

Dexmedetomidine added to supraclavicular block

Abstract

Introduction: Supraclavicular brachial plexus blocks are widely used for perioperative anesthesia and analgesia. Dexmedetomidine is a highly selective alpha-2 receptor agonist that provides analgesia, sedation, and anxiolysis. Our study aims to evaluate the effect of the addition of dexmedetomidine with bupivacaine and xylocaine with adrenaline in supraclavicular block in upper limb surgeries.

Method: This was a comparative study conducted at Patan Hospital, Nepal among 44 patients randomly assigned in Group-I (N=22, bupivacaine and xylocaine with adrenaline 28 ml + dexmedetomidine 2 ml 1 mcg/kg), and Group-II (N=22, without dexmedetomidine) for ultrasound-guided supraclavicular block for upper limb surgeries. The study was approved by the institutional review committee. Onset of sensory and motor block, duration of analgesia, demographics, hemodynamic parameters, and side effects of drugs were compared. The Pin-prick test and the modified Bromage scale were used to evaluate sensory and motor blockades and the visual analogue scale for the severity of pain. Statistical analysis was performed with SPSS v16.

Result: The median time for the onsets of sensory and motor blocks was significantly shorter in GI (1 m and 3 m) than in GII (5 and 10 m). The duration of analgesia was longer in group I (720 m) than in group II (360 m). Two patients had bradycardia and one had hypertension in the dexmedetomidine group, which were managed successfully.

Conclusion: Dexmedetomidine added to local anesthetics significantly prolongs the effect of supraclavicular block in upper limb surgeries.

Keywords: Bupivacaine, dexmedetomidine, supraclavicular block, ultrasound guided, upper limb surgery, xylocaine with adrenaline