A Comparative Study of Clonidine and Dexmedetomidine as an Adjuvant in Supraclavicular Brachial Plexus Block

Abstract

BACKGROUND Supraclavicular block provides anaesthesia for upper extremity in the most consistent andf efficient manner of any brachial plexus technique. Adjuvants when added to local anaesthetics enhance the onset and prolongs the duration of block. α2 agonists produce analgesia, sympatholysis and sedation, hence considered as effective adjuvant. The aim of this study is to compare the efficacy and safety of two α2 agonists, i.e. clonidine and dexmedetomidine as an adjuvant for brachial plexus block. MATERIALS AND METHODS It was a prospective, randomised and double-blind study. Sixty patients of ASA grades I and II undergoing forearm surgeries were randomly divided into two groups of 30 patients each. Group C patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Clonidine 1 μg/kg. Group D patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Dexmedetomidine 1 μg/kg. Parameters noted were onset, completion and duration of sensory and motor block, duration of analgesia, Ramsay sedation score, vital parameters and complications if any. Results were analysed by student's unpaired 't' test and chi-square test. RESULTS Onset and time for complete sensory and motor block was significantly faster in the dexmedetomidine group when compared to the clonidine group. The total duration of sensory and motor block and duration of analgesia was also significantly longer in Group D. Both the groups had stable haemodynamics. No complications or side effects were observed in both the groups. CONCLUSION Dexmedetomidine can be used as an adjuvant, alternative to clonidine in supraclavicular brachial plexus block with prolongation of both sensory and motor block, and without any haemodynamic instability and systemic side effects.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials

“…1 ). 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 Among 24 included studies, 21 were double-blind and 2 were open-label. One study did not specify the type of blinding.…”

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”