An evaluation of the addition of Dexmedetomidine to Levobupivacaine for supraclavicular brachial plexus block in upper limb orthopaedic surgeries

Dixit, Atul; Singhal, Shakti; Neema, Charu; Sanwatsarkar, Sadhna; Bhatia, Manohar

doi:10.21276/apjhs.2015.2.2.23

Cited by 7 publications

(12 citation statements)

References 10 publications

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“…However, bradycardia did not occur in our study so there was no need for pharmacological intervention. Our findings are in concordant with the findings of Atul Dixit et al [21] who also found a decrease in heart rate after giving 1µg/kg Dexmedetomidine with Levobupivacaine but the mean heart rate remained to be normal.…”

Section: Intraoperative Heart Rate Changessupporting

confidence: 93%

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

Arora¹,

Bhatt²,

Kabir³

2021

Int. J. Med. Anesthesiology

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Introduction: Dexmedetomiodine is a selective α2 agonist drug. This study aimed to assess the onset and duration of sensory and motor block and postoperative analgesia in the first 12 hours after surgery after adding Dexmedetomidine with 0.375% Levobupivacaine for brachial plexus block. Material and Method: 100 patients aged 18-60 years of ASA Grade I & II posted for upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups with 50 patients in each. Group L and L+D received 35cc of 0.375% injection Levobupivacaine and 35cc of 0.375% Levobupivacaine with 1 µg/kg of injection Dexmedetomidine respectively through nerve stimulator guided supraclavicular block. Onset and duration of sensory and motor block, time to first and total analgesic need were noted postoperatively for 12 hours. Results: Sensory and motor block onset time was significantly lower in the Group L+D than Group L (p=0.001). Duration of sensory and motor block was significantly longer in the Group L+D than Group L (p=0.001). The time to the first analgesic requirement was longer in Group L+D than Group L (p=0.001). The total analgesic requirement was significantly lower in Group L+D than Group L (p=0.001).Heart rate and systolic and diastolic blood pressure was significantly lower after drug administration in group L+D than group L. Conclusion: Dexmedetomidine added to Levobupivacaine causes early onset and increased duration of sensory and motor block and prolonged period of postoperative analgesia in supraclavicular brachial plexus block. Therefore, Dexmedetomidine seems to be a good alternate adjuvant.

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Section: Intraoperative Heart Rate Changessupporting

confidence: 93%

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

Arora¹,

Bhatt²,

Kabir³

2021

Int. J. Med. Anesthesiology

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

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“…The mode of nerve block localization was anatomical (landmark) in six trials, 10 42 43 45-48 nerve stimulation in 20 trials, ultrasound in three trials, 8 55 63 a combination of nerve stimulation and ultrasound in four trials, 9 58 59 65 and not defined in one trial. 44 With the exception of one trial that used mepivacaine, 66 all trials used long-acting LAs (ropivacaine, bupivacaine, or levobupivacaine) alone or in conjunction with short acting LAs; and three trials used epinephrine in all study arms. 60 64 65 Perineural dexmedetomidine was used in either weight-based doses (0.75 to 1.0 mg/kg) or flat doses (10 to 150 mg).…”

Section: Trial Characteristicsmentioning

confidence: 99%

“…( Supplementary Fig. S4) Excessive postoperative sedation was reported using various scales, including Richmond, 49 56 Modified Wilson, 46 University of Michigan, 44 and four-point sedation scales; 65 it was undefined in three trials. 9 55 67 Patients who received perineural dexmedetomidine had greater odds of experiencing excessive postoperative sedation, with an OR of 17.2 [1.04, 286.5], (P ¼ 0.05, I 2 ¼ 78%).…”

Section: Dexmedetomidine-related Adverse Effectsmentioning

confidence: 99%

Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials

Vorobeichik

Brull

Abdallah

2017

British Journal of Anaesthesia

174

145

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An evaluation of the addition of Dexmedetomidine to Levobupivacaine for supraclavicular brachial plexus block in upper limb orthopaedic surgeries

Cited by 7 publications

References 10 publications

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

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

Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials

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