Clonidine Combined with a Long Acting Local Anesthetic Does Not Prolong Postoperative Analgesia after Brachial Plexus Block but Does Induce Hemodynamic Changes

Culebras, Xavier; Gessel, E. Van; Hoffmeyer, Pierre; Gamulin, Z.

doi:10.1097/00000539-200101000-00038

Cited by 126 publications

(91 citation statements)

References 13 publications

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“…The two groups showed no clinically significant difference in onset and duration of motor and sensory blockade. 18 Sedation after provision of block was assessed using the sedation score described by Culebras et al 5 The results of our study were similar to those obtained by Agarwal S et al where dexmedetomidine was added to bupivacaine and sedation was assessed using modified Ramsay sedation score. 19 They observed that patients who received dexmedetomidine had higher sedation scores.…”

Section: Discussionsupporting

confidence: 83%

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Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Mathew

Prasad

Krishna

et al. 2017

Sri Lankan J Anaesthesiol

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Context: Ultrasound (US) guided supraclavicular brachial plexus block (SBPB) provides predictable dense blockade. Inclusion of additives to local anaesthetics alters the quality of blockade. Aim:To assess the block characteristics of ropivacaine alone and with additives in US guided SBPB. Materials and Methods:Prospective, double blinded randomized controlled trial. Sixty patients undergoing elective upper limb surgeries under SBPB were randomly allocated to one of 3 groups: Group RR (who received 30ml of 0.5% ropivacaine), Group RD (30ml of 0.5% ropivacaine with 1 µ g/kg of dexmedetomidine) and Group RM (30ml of 0.5% ropivacaine with 50µ g/kg of midazolam). After administration of block with above drugs, the block characteristics were assessed every 3mins till onset of complete blockade, every 30mins for 6hrs, then hourly for 24hrs. Apart from sensory and motor blockade, sedation score was also assessed. Results:The duration of blockade (min) was significantly longer in Group RD (907 ± 205) compared to Group RR (597 ± 101) and Group RM (605 ± 188). There was no difference among the groups with respect to onset of sensory and motor blockade. The sedation scores were significantly higher in Group RD (median = 3) and Group RM (median = 2). Conclusion:Addition of dexmedetomidine to ropivacaine in ultrasound guided supraclavicular brachial plexus block prolongs both sensory and motor blockade. Both dexmedetomidine and midazolam when added to ropivacaine produce significant sedation.

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Section: Discussionsupporting

confidence: 83%

“…Grade 2: Complete motor block with inability to move below wrist and fingers. Sedation was assessed using sedation score described by Culebras et al 5 Score 1: Awake and alert. Score 2: Sedated, responding to verbal stimulus.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Mathew

Prasad

Krishna

et al. 2017

Sri Lankan J Anaesthesiol

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“…Furthermore, mixed epinephrine to bupivacaine could have masked any pharmacodynamic effect of perineural magnesium, similar to the report in which clonidine failed to prolong the analgesic duration of ropivacaine and bupivacaine with epinephrine. 15 In conclusion, the addition of magnesium sulphate to a bupivacaine-epinephrine mixture for interscalene nerve block prolonged the duration of analgesia and decreased postoperative pain after rotator cuff repair. From a clinical standpoint, the results might be modest because adding magnesium to bupivacaine did not reduce the postoperative opioid consumption.…”

Section: Discussionmentioning

confidence: 86%

Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block

Lee

Chung

et al. 2011

Can J Anesth/J Can Anesth

112

103

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Purpose Local anesthetic adjuvants have been studied previously in an attempt to prolong the duration of analgesia after peripheral nerve blockade. Magnesium has been shown to have an antinociceptive effect in animal and human pain models. We evaluated the effects of adding magnesium sulphate to long-acting local anesthetics for interscalene nerve block to prolong the duration of analgesia and improve the analgesic quality. Methods We enrolled 66 patients undergoing arthroscopic rotator cuff repair. The interscalene nerve block was performed with 0.5% bupivacaine 20 mL with epinephrine (1:200,000) plus either 10% magnesium sulphate 2 mL (Magnesium Group) or normal saline 2 mL (Saline Group). The following data were recorded for 24 hr after surgery: onset times and durations of sensory and motor blocks, analgesic duration, the pain numeric rating scale (NRS), postoperative fentanyl consumption, and complications. Results The duration of analgesia was longer in the Magnesium Group than in the Saline Group [mean and (standard deviation) 664 (188) min vs 553 (155) min, respectively; P = 0.017]. Patients in the Magnesium Group had significantly reduced pain NRS scores at 12 hr (P = 0.012), but the cumulative fentanyl consumption was similar in both groups. The onset times and durations of sensory and motor blocks were not significantly different between the two groups. Conclusion The addition of magnesium sulphate to a bupivacaine-epinephrine mixture for interscalene nerve block prolongs the duration of analgesia and reduces postoperative pain.

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“…Only patients with complete motor block were included in the study. Sedation was assessed using the sedation score described by Culebras et al 6 (1-awake and alert, 2-sedated, responding to verbal stimulus, 3-sedated, responding to mild physical stimulus, 4-sedated, responding to moderate or severe physical stimulus, 5-not arousable). Heart rate, noninvasive blood pressure, oxygen saturation and sedation score were measured every five minutes until the end of surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Various studies have investigated several adjuncts, including opioids, clonidine, neostigmine, hyaluronidase, and bicarbonate. [5][6][7][8][9] The results have been inconclusive, because of associated side effects or doubtful efficacy. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and to enhance the effect of local anesthetic when given epidurally or intrathecally.…”

Section: Conclusion : Le Midazolam (50 µG·kg -1 ) Combiné à 30 ML De mentioning

confidence: 99%

Brachial plexus block with midazolam and bupivacaine improves analgesia

Jarbo

Batra

Nidhi

et al. 2005

Can J Anesth/J Can Anesth

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Purpose: Adjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anesthetics when given epidurally or intrathecally. The purpose of this study was to assess the effect of midazolam added to brachial plexus anesthesia. Methods:A prospective, randomized, double blind study was conducted on 40 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 20) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 20) were given 30 mL of 0.5% bupivacaine with midazolam 50 µg·kg -1 . Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hr postoperatively. Results:The onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Pain scores were significantly higher in Group B compared to Group BM from two hours to 24 hr postoperatively (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period. Conclusion:Midazolam (50 µg·kg -1 ) in combination with 30 mL of bupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events. Objectif

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Clonidine Combined with a Long Acting Local Anesthetic Does Not Prolong Postoperative Analgesia after Brachial Plexus Block but Does Induce Hemodynamic Changes

Abstract: Clonidine in brachial plexus block does not improve postoperative analgesia when mixed with a long-lasting anesthetic. Nevertheless, with or without clonidine, bupivacaine in interscalene block provides a long-lasting analgesia of approximately 15 h.

Cited by 126 publications

References 13 publications

Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block

Brachial plexus block with midazolam and bupivacaine improves analgesia

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