Comparative Study of Intravenous Dexmedetomidine Sedation With Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block in Upper Limb Orthopaedic Surgery

Abstract

Background Dexmedetomidine is being used as an adjuvant analgesic, both as intravenous (IV) and intrathecal infusion. The role of perineural (P) dexmedetomidine has evoked attention recently. The aim of this study was to compare the effect of IV dexmedetomidine and P dexmedetomidine as an adjunct to supraclavicular brachial plexus block in upper limb orthopaedic surgery. Methods Patients were randomly divided into two equal groups (n=20). Group I (IV dexmedetomidine) received dexmedetomidine 1 mcg/kg IV as loading dose over 10 minutes, followed by continuous infusion of dexmedetomidine 0.4 mcg/kg/hr IV. Group P (P dexmedetomidine) received dexmedetomidine at 1 mcg/kg perineurally. After adequate motor response with the aid of peripheral nerve stimulator a supraclavicular block with 40 ml solution containing 5 mg/kg lignocaine (2%) with adrenaline (1:200,000) and 2 mg/kg of bupivacaine (0.5%) was injected to both the groups. Group P also received dexmedetomidine perineurally with block. Onset and duration of sensory and motor block, Ramsay sedation score, hemodynamic parameters, and postoperative analgesia requirement were assessed along with side effects. The data obtained were recorded as mean ± SD, ranges, numbers, and ratios. Results were analyzed using the chi-square test, the Mann-Whitney test for non-parametric data, and an unpaired ‘t’-test for parametric data. Statistical analysis was carried out using the SPSS (version 10, 2002; SPSS Inc., Chicago, IL, USA) for Windows statistical package. P value less than 0.05 was considered statistically significant. Results Mean onset of sensory block was earlier in group I than in group P (p<0.05) although mean onset of motor block was not significantly different (p>0.05). Duration of sensory and motor blockade was longer in group I (p<0.05). Patients in group I demonstrated lower pulse rate and lower systolic and diastolic blood pressures throughout the period with comparable SpO 2 values. There was no difference in intraoperative Ramsay sedation scores in both groups, but postoperative Ramsay sedation scores at 9, 12, and 15 hours were better in group I (p<0.05). The average time to rescue analgesia (visual analogue scale >4) was higher in group I (p>0.05). Conclusion IV dexmedetomidine produced early onset of sensory block, longer duration of sensory and motor block, and longer duration of analgesia as compared with P dexmedetomidine as an adjuvant to supraclavicular block with 5 mg/kg lignocaine (2%) and 2 mg/kg bupivacaine (0.5%) in upper limb orthopaedic surgeries.

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

“…Sehmbi et al 55 showed that intravenous dexmedetomidine infusion did not prolong the sensation, motor, or pain relief duration. Samar et al 56 revealed that intravenous dexmedetomidine could produce sensory block earlier, with a longer sensory and motor block and analgesia duration. Regarding the onset and duration of block and duration of analgesia, Somsunder et al 57 discovered that intravenous dexmedetomidine was equally effective as epineural dexmedetomidine, but the hemodynamic fluctuation was larger.…”

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

“…Upper limb surgery is often performed under brachial plexus block (BPB), which is a series of regional anesthesia techniques and also contributes to reliable postoperative analgesia [ 1 ]. Single block and continuous catheter-based block are two different anesthesia regimens.…”

Successful Management of Parkinson's Disease Dyskinesia During Local Anesthesia With Dexmedetomidine

“…Generally, respiratory suppression induced by DEX is lesser than that induced by other sedation agents [11]. There are also two reports that the combined use of DEX with local anaesthesia prolonged the effect of the local anaesthetic [12,13]. Although it is not a common method of administration and is still in the research stage, there is a report that DEX administered into the subarachnoid region of the spinal cord produced a mild sedative effect while enhancing the effects of spinal anaesthesia [14].…”