A Comparative Clinical Study to Evaluate the Efficacy of Levobupivacaine With Clonidine and Levobupivacaine With Dexmedetomidine in Supraclavicular Brachial Plexus Block

Abstract

The objective of this study is to compare clonidine and dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset, duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS A total of 90 ASA grade I and II patients of either sex, aged 18-60 yrs. scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into 3 equal groups in a randomized fashion. Group L (n=30) received 1 mL NS, group LC (=30) received 1 mL (150 g) clonidine and group LD (n=30) received 1 mL (100 g) dexmedetomidine added to 30 mL of 0.5% levobupivacaine. Onset and recovery time of sensory and motor block, duration of analgesia and quality of block were studied in all three groups. RESULTS Onset time of sensory and motor blockade was 12.43±2.56 min and 17.96±3.05 min respectively in group L, 9.03±1.60 min and 15.00±2.40 min respectively in group LC and 8.13±2.51 min and 12.13±2.89 min respectively in group LD. Duration of sensory and motor blockade was 660.16±44.28 min and 535.33±50.66 min respectively in group L, 880.16±55.48 min and 771.83±54.19 min respectively in group LC and 930.66±48.02 min and 811.83±52.08 min respectively in group LD. Time of rescue analgesia was 728.86±45.12 min in group L, 1013.5±59.01 min in group LC and 1159.8±56.8 min in group LD (p<0.05). CONCLUSION Dexmedetomidine when added to LA in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and also the time for rescue analgesia as compared to clonidine. Dexmedetomidine also enhances quality of block (LD>LC>C).

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

“…Across all included studies, a total of 3332 patients were assessed. DEX was used as an adjuvant to several different local anesthetics, which included ropivacaine [ 23 , 34 , 39 , 41 , 42 , 45 – 47 , 49 , 50 , 52 , 56 , 57 , 59 , 63 – 66 , 68 , 72 – 74 , 76 , 78 , 80 , 81 , 84 , 85 ], bupivacaine [ 20 , 35 , 37 , 38 , 40 , 51 , 53 – 55 , 67 , 69 , 71 ], levobupivacaine [ 21 , 43 , 44 , 48 , 60 – 62 , 79 , 83 ], and lidocaine [ 22 , 36 , 70 , 77 , 86 ]. Across the studies, the dose of DEX ranged from 0.5 μg/kg to a total of 150 μg.…”

“…The incidence of bradycardia and hypotension was described in 28 studies [ 23 , 34 – 37 , 39 – 42 , 45 , 47 , 48 , 51 – 53 , 58 , 61 , 63 , 64 , 66 , 67 , 69 , 78 – 80 , 83 – 85 ] and 26 studies [ 23 , 34 – 36 , 39 – 42 , 45 – 48 , 51 – 53 , 58 , 63 , 64 , 66 , 67 , 69 , 78 – 80 , 84 , 85 ] respectively. Pooled analysis showed that perineural DEX>60 μg increased the risk of bradycardia (risk difference [RD]: 0.16, 95% CI: 0.06 to 0.26, I 2 = 97%, P = 0.002) (Fig.…”

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

“…Similarly, pairwise meta‐analysis of 53 trials for sensory block duration [73–111, 113–122, 125, 126, 128, 129] and 53 trials for motor block duration [73–111, 113–122, 125, 126, 128, 129] comparing perineural dexmedetomidine vs. control arms did not reveal any sub‐group differences by indexing status (see online Supporting Information). Consequently, indexed and non‐indexed papers were pooled and analysed in the network, as decided a priori.…”

Alpha2‐receptor agonists as adjuvants for brachial plexus nerve blocks—A systematic review with meta‐analyses

“…45,[63][64][65]78,80 Nineteen trials compared dexmedetomidine with clonidine in 1130 patients. 31,42,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] Different doses of adjuvants were compared in seven trials. 17,22,30,40,62,64,86 One trial tested clonidine with different local anaesthetics 25 (Table 1).…”

“…The duration of BPB was 205 min (TSA adj. 95% CI 162, 249; p < .00001; 1030 patients; 19 trials) 31,42,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] longer for dexmedetomidine compared with clonidine (weighted mean duration in clonidine group 481 min) (Figure 4, Appendix S7 and Table 2).…”