Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study

Swami, Sarita S; Keniya, Varshali M; Ladi, Sushma; Rao, R Bhavani

doi:10.4103/0019-5049.98767

Cited by 184 publications

(231 citation statements)

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“…8 Swami et al concluded that dexmedetomidine (1μg/kg) when added to local anaesthetic (bupivacaine 0.25%) in SBPB increased the duration of sensory and motor block and also the duration of analgesia. 3 Similar prolongation of duration of block was also observed by Esmaoglu et al in their study to evaluate the effect of dexmedetomidine (100µg) as additive to levobupivacaine (40ml of 0.5% levobupivacaine) in axillary brachial plexus block. 9 Zhang et al also recorded prolonged sensory and motor blockade duration in patients who received 50μg dexmedetomidine in 40ml of 0.33% ropivacaine when compared to control group for axillary brachial plexus blockade.…”

Section: Discussionsupporting

confidence: 58%

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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: 58%

“…Motor block was graded using modified Bromage scale for upper extremities. 3 Grade 0: Normal motor function. Grade 1: Ability to move only fingers.…”

Section: Methodsmentioning

confidence: 99%

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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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“…4,5 One negative aspect that hinders the single-shot technique is the limited duration of action of the local anesthetic. Although several studies have described prolonging the block with adjuvants, such as dexmedetomidine, clonidine, and epinephrine, 6,7 limited data exist on the safety profile of placing these adjuvants adjacent to the neural tissues. Consequently, patients who have been discharged after undergoing a single-shot supraclavicular block during a procedure may experience postoperative pain shortly after arriving home from the hospital, or even in transit.…”

Section: Résumémentioning

confidence: 99%

“…Based on other reported data 7 and our clinical experience, we estimated the duration (SD) of analgesia to be 300 (60) min after a single-shot supraclavicular block. We expected the second bolus of local anesthetic given through the catheter in the PARR to have a similar duration of action and assumed it would prolong the duration of analgesia by at least 90 min compared with the control group.…”

Section: Sample Size Calculationmentioning

confidence: 99%

The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: a randomized controlled study

Tsui

2013

Can J Anesth/J Can Anesth

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The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: a randomized controlled study L'assemblage cathéter sur aiguille facilite l'administration d'un deuxième bolus d'anesthésique local pour prolonger la durée du bloc supraclaviculaire du plexus brachial sans longues étapes de cathétérisation: une étude randomisée contrôlée Abstract Background Single-shot delivery of a supraclavicular brachial plexus block is effective for providing outpatient surgical anesthesia; however, patients generally must use oral analgesics to control pain shortly after discharge from the hospital. Catheterized delivery of supraclavicular blocks can be challenging to perform. We aimed to show that administering a second postoperative bolus of local anesthetic through a catheter placed by a catheter-overneedle assembly not only avoids time-consuming steps but also provides an extended analgesic effect compared with the traditional single-shot approach. Methods Patients were randomized into two groups: one group received a single-shot supraclavicular block with 25-30 mL of local anesthetic (1.5% lidocaine and 0.125% bupivacaine mixture), while the other group received a supraclavicular block via a catheter-over-needle assembly with the same volume and concentration of local anesthetic as for the single-shot block, which was followed by a second bolus of analgesic solution (0.2 % ropivacaine 20 mL) administered postoperatively through the catheter before its removal. The duration between the initial bolus and onset of pain was measured as well as the duration of pain relief from the last bolus. Results Thirty patients were enrolled and randomized into the single-shot supraclavicular block group (n = 15) and the catheter-over-needle group (n = 15). One patient withdrew from the study, and five patients were lost to follow-up. We observed no significant difference between the two groups in time to perform the blocks. The mean (standard deviation [SD]) times were 3.1 (1.9) min and 4.4 (2.7) min for the top-up group and single-shot group, respectively (single-shot took 1.3 min longer than the catheter-over-needle group; 95% confidence interval [CI]: -0.65 to 3.25; P = 0.17). The mean (SD) duration of analgesia, measured from the beginning of the local anesthetic bolus to the onset of pain requiring rescue analgesia was 617.5 (288) min in the catheter-over-needle group and 377.2 (161.3) min in the single-shot control group (difference = 240.3 min; 95% CI: 46.8 to 433.8; P = 0.03). Conclusions Using the catheter-over-needle assembly for supraclavicular brachial plexus block facilitated effective delivery of a supplementary bolus of local anesthetic without extending the time to perform the block or increasing the number of steps. It also prolonged analgesia significantly compared with the single-shot approach. This trial was registered at: ClinicalTrials.gov, ID: NCT01522066.Author contributions Vivian Ip and Ban Tsu...

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Analgesic Strategies in Ambulatory Surgery Centers

Lane

2021

Pain Control in Ambulatory Surgery Centers

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Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study

Cited by 184 publications

References 18 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

The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: a randomized controlled study

Analgesic Strategies in Ambulatory Surgery Centers

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