INTRODUCTIONPeripheral nerve block has taken patient care in anaesthesia to a whole new level. Because of the advent of nerve stimulator and peripheral nerve block techniques, even patients in ASA grade 3 and 4 can be taken up for surgery safely. Moreover, with the use of adjuvants in brachial plexus block (BPB), one can extend patient care in the form of extended postoperative analgesia, ensure compliance of patient with physiotherapy and early mobilization of patient with stable haemodynamic variables. Dexmedetomidine is a highly selective α-2 adrenergic agonist with an affinity of 8 times greater than clonidine.
1Various studies have shown that dexmedetomidine prolongs the duration of sensory and motor block and provide a very good analgesia when used as an adjuvant to local anaesthetics for nerve blocks.2-5 The anaesthetic and the analgesic requirement are reduced substantially because of its analgesics properties and augmentation of local anaesthetics (LA) effects as they cause hyperpolarization of nerve tissues by altering transmembrane potential and ion conductance at locus ceruleus in brain stem. Dexmedetomidine provides stable ABSTRACT Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an α-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine. Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50μg of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups. Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.
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