The surgeries in the upper limb can be done by general or regional anesthesia or both. Nowadays regional anesthesia has wide application in providing surgical anesthesia, complete muscle relaxation, better hemodynamic stability and post-operative analgesia as well as in treating chronic pain syndromes. The sympathetic block produced by regional anesthesia reduces vasospasm. 1 Regional anaesthesia has several advantages in the postoperative period compared with general anaesthesia, including decreased sedation, decreased nausea and vomiting, early discharge from the recovery room and a smooth transition to pain control as the block effects gradually dissipate. Various adjuvants like morphine, fentanyl, sufentanil, dexamethasone, midazolam, ketamine, neostigmine, sodium bicarbonate are added to local anesthetic agents during regional anesthesia. 2 Alpha 2 receptor agonists clonidine and dexmedetomidine are of new interest in regional anesthesia because of their better haemodynamic stability, sedation and longer duration of postoperative ABSTRACT Background: Supraclavicular brachial plexus block is used commonly for upper limb orthopedic procedures. Among the adjuvants used to improve the quality of block induced by bupivacaine the alpha 2 agonists are of new interest. This study was done to compare dexmedetomidine and clonidine as adjuvants to bupivacaine for supraclavicular brachial plexus block in upper limb orthopedic surgeries. Methods: 60 ASA I/II patients aged between 20 and 50 years undergoing upper limb orthopedic procedures were selected and divided into two groups of 30 each. Group C received 35 ml of 0.375% Bupivacaine and clonidine 2µg/kg while Group D received 35 ml of 0.375% bupivacaine and dexmedetomidine 2 µg/kg. Onset time to sensory and motor blockade, vitals, complete duration of motor and sensory block, total duration of analgesia and side effects were noted. Results: The mean time of onset for sensory block and motor block in Group D was lower when compared to Group C. Except at 5 th minute the pulse rate and mean arterial pressure were lower in Group D when compared to Group C. The mean time for total duration of sensory block and motor block was more in Group D when compared to Group C. The total duration of analgesia was higher in Group D than in Group C. Conclusions: The addition of dexmedetomidine to bupivacaine during supraclavicular brachial plexus block produces a shorter onset of time to sensory and motor block with prolonged duration of analgesia when compared to clonidine added to bupivacaine.
INTRODUCTIONPain in labour is an extremely agonising experience for most women. Various methods have been tried since time immemorial to alleviate this pain. However, this endeavor did not receive much support till the late 19th century, with analgesia for labour being opposed for both medical and religious reasons. It was also believed that ABSTRACT Background: Pain in labour is an extremely agonising experience for most women. Unrelieved labour pain produces many physiological changes which are detrimental to both the mother and the foetus. Various methods have been used to alleviate this pain. It is now well recognized that the only consistently effective method of pain in labour is lumbar epidural analgesia. Using a higher concentration of local anaesthetic agent to produce analgesia can be associated with undesirable side effects such as motor block, haemodynamic disturbances or interference with the progress of labour. Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. In view of the above, the present study assesses the clinical effectiveness of continuous lumbar epidural analgesia for vaginal delivery by using 0.0625% bupivacaine with 2µg/ml of fentanyl. Methods: Forty parturient admitted to Chennai Medical College and Hospital, Trichy, for vaginal delivery and who were in active labor was given 8 ml of 0.0625% bupivacaine with 2µg/ml of fentanyl. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome. Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes). A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 µg of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate.
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