COMPARISON BETWEEN 0 . 5% BUPIVACAINE - DEXAMET HASONE COMBINATION & 0 . 5% BUPIVACAINE - CLONIDINE COMBINATION IN BRACHIAL PLEXUS BLOCKS BY SUPRACLAVICULAR APPROACH

Abstract

BACKGROUND: Brachial plexus blocks, alone or in combination with general anesthesia, has become one of the most important anesthesia techniques for surgeries in the upper limb. Prolongation of analgesia using perineural catheters are not yet popular, and we are in need for an adjuvant that can prolong the action of local anesthetics after single injection peripheral nerve blocks. Dexamethasone and clonidine are two commonly used adjuvants. This study was undertaken to compare the analgesic efficacy of dexamethasone and clonidine. MATERIALS AND METHODS: Ninety adult patients fitting under the inclusion criteria were assigned to three groups of thirty each and received ultrasound guided supraclavicular brachial plexus block. They received either dexamethasone 8 mg (Group D) or clonidine 1mcg/kg (Group C) or saline 2 ml (Group S) with 15 ml of 0.5% bupivacaine. The onset of sensory and motor blocks, duration of analgesia and the duration of motor block were assessed. RESULTS: The onset of sensory and motor block were comparable in all the three groups (17.50±2.86 minutes and 30.33±4.14 minutes; 17.17±3.13 minutes and 31.0±4.8 minutes; 18.33±3.55 minutes and 31.0±5.48 minutes for groups D, C and S respectively. The duration of analgesia and motor blockade was markedly prolonged in dexamethasone group (19.41±2.60 hours and 17.19±2.13 hours) and moderately prolonged clonidine group (11.49±1.66 hours and 10.41±1.18 hours) when compared to saline group (7.56±1.65 hours and 6.22±1.43 hours). CONCLUSION: Dexamethasone proves to be a better adjuvant compared to clonidine, as it considerably prolongs analgesia and is devoid of significant side effects. But the prolonged motor block is still a matter of concern and the search for an adjuvant that selectively prolongs analgesia without impairing motor function continues.

A Comparison Between Dexamethasone and Clonidine as Adjuvants to Levobupivacaine in the Supraclavicular Approach to the Brachial Plexus Block: A Double-Blind Study

“…Our observations are in accordance with a similar study published in 2015 by Kishore et al [8,23], who compared the addition of dexamethasone in a dose of 8 mg (group D), clonidine in a dose of 1 mcg/kg (group C), and saline 2 mL (group S) with 15 mL of 0.5% bupivacaine in BPB by supraclavicular approach and observed that dexamethasone turned out to be a better adjuvant as compared to clonidine, as it significantly extend the analgesia duration, without any significant side effects.…”

“…The time of onset for sensory and motor blocks in group LD was similar to group LC and group L (p>0.05) in our study. Similar results were observed in several earlier published studies [7][8][9]. Dar et al [7] published a study that showed a significantly early onset of sensory and motor blocks in the dexamethasone group compared to the ropivacaine group (p<0.05).…”

Perbedaan Respons Hemodinamik antara Penggunaan Levobupivakain dan Penambahan Klonidin 1 dan 2 Mcg/kgBB pada Scalp Block

“…Penambahan klonidin 1 mcg/kgBB ternyata cukup memberi efek perubahan pada diberikan atropin 0,6 mg intravena. 14 Klonidin dapat menyebabkan penurunan resistensi vaskular sistemik yang dimediasi secara sentral dan juga melalui reseptor α2, serta melalui peningkatan tonus vagal yang mengakibatkan penurunan tekanan arteri rerata dan laju detak jantung. Hal ini juga menyebabkan penurunan sekresi norepinefrin dari ujung saraf perifer sehingga mengurangi respons stres.…”