Comparative study between dexamethasone and dexmedetomidine in supraclavicular block

Abstract

INTRODUCTIONPeripheral nerve block has taken patient care in anaesthesia to a whole new level. Because of the advent of nerve stimulator and peripheral nerve block techniques, even patients in ASA grade 3 and 4 can be taken up for surgery safely. Moreover, with the use of adjuvants in brachial plexus block (BPB), one can extend patient care in the form of extended postoperative analgesia, ensure compliance of patient with physiotherapy and early mobilization of patient with stable haemodynamic variables. Dexmedetomidine is a highly selective α-2 adrenergic agonist with an affinity of 8 times greater than clonidine. 1Various studies have shown that dexmedetomidine prolongs the duration of sensory and motor block and provide a very good analgesia when used as an adjuvant to local anaesthetics for nerve blocks.2-5 The anaesthetic and the analgesic requirement are reduced substantially because of its analgesics properties and augmentation of local anaesthetics (LA) effects as they cause hyperpolarization of nerve tissues by altering transmembrane potential and ion conductance at locus ceruleus in brain stem. Dexmedetomidine provides stable ABSTRACT Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an α-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine. Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50μg of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups. Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.

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

“…Both animal [144] and human volunteer [145] studies indicate that unlike dexamethasone, dexmedetomidine exerts its anti-nociceptive effects locally, through perineural mechanisms. Hence, it is not surprising that we found perineural dexmedetomidine to hasten the sensory and motor onset times compared with dexamethasone, as observed in previous studies [146].…”

Comparison of ultrasound guided interscalene brachial plexus block using 0.2% ropivacaine with dexmedetomidine and 0.2% ropivacaine with dexamethasone - A prospective observational study

“…Time to request of first rescue analgesia was also prolonged in group Dexmed (930 ± 83.45 min) than in group Dexa (620 ± 125.54 min), which is clinically and statistically significant ( Table 2). Our results were similar to the results obtained by Verma NK et al and Kaur M et al 13,14 However Lee MJ et al observed that the sensory blockade was prolonged with dexmedetomidine or dexamethasone as adjuvants compared to plain ropivacaine, but there was no significant intergroup difference between dexmedetomidine and dexamethasone. Significant differences in onset time was not noticed among three groups, which is attributable to the higher dose of local anaesthetic.…”

Comparison of dexamethasone and dexmedetomidine as adjuvants to bupivacaine in supraclavicular brachial plexus block: A prospective randomized study

“…11 Kaur et al compared the effects of 8 mg of dexamethasone with 50 µg of dexmedetomidine as an adjuvant with a mixture of 20 ml of 2% lignocaine with adrenaline and 18 ml of 0.5% bupivacaine in supraclavicular block. 16 They found that dexmedetomidine prolonged the block when compared with dexamethasone. Contrary to these studies, our study showed a significantly prolonged block with dexamethasone.…”