Effect of dexmedetomidine as adjuvant in supraclavicular block for upper limb orthopedic surgeries

Abstract

INTRODUCTIONRegional anesthesia is one of the most challenging and satisfying modalities for anaesthesiologist. The use of peripheral nerve blocks for anesthesia and post op analgesia has increased frequently in recent years. Upper extremities orthopaedic surgeries can be performed safely in brachial plexus block as sole anaesthesia and offers many advantage over general anaesthesia, such as improved postoperative pain relief, early recovery, less PONV and no or minimal systemic side effects of anaesthesia drugs and analgesics. 1,2 Brachial plexus block given by different approaches like axillary, supraclavicular, infraclavicular and interscalene block. But among all approaches, Supraclavicular block for forearm surgeries provide consistent, reliable, complete and uniform upper extremity anaesthesia with ABSTRACT Background: Dexmedetomidine has anxiolytic, sedative, hypnosis, analgesic, antisialogogue and sympatholytic properties which render it suitable as an adjuvant. Hence this study was aimed to prove its efficacy as an adjuvant to lignocaine and bupivacaine for supraclavicular block in patients undergoing orthopedic upper limb surgeries. Other objectives of the study were to evaluate and compare the onset and duration of sensory and motor block as well as total analgesia, to compare effect on hemodynamic and respiratory parameters and to study any adverse effect associated with dexmedetomidine as adjuvant. Methods: Sixty patients of ASA physical status class I & II of elective upper limb forearm orthopedic surgeries were selected in our study. Patients in group NS (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 ml normal saline for supraclavicular block and group D (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 µg/kg of Dexmedetomidine for the same block. The onset and duration of sensory and motor block, total duration of analgesia, need of rescue analgesic postoperatively, postoperative VAS score was assessed and compared between the two groups. Results: Demographic data and surgical characteristics are comparable in both the groups. The onset of sensory and motor block was significantly lower (p <0.05) in group D than in group NS. The duration of sensory and motor block was significantly higher (p <0.01) in group D when compared to group NS. The duration of analgesic requirement postoperatively was significantly higher (p <0.01) in group D than group NS. No significant change in observations was made for hemodynamic parameters in both the groups. Conclusions: Dexmedetomidine can be considered as an adjuvant to lignocaine and bupivacaine mixture for excellent quality supraclavicular block without any side effects and provide good sedation in patients undergoing orthopedic upper limb surgeries.

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

“…Fifty‐four trials used bupivacaine as their long‐acting local anaesthetic [32–35, 38, 40–44, 46–48, 50, 51, 54, 55, 57–59, 61, 62, 64–66, 68–72, 76, 77, 79, 85, 89–91, 93, 94, 98–101, 103, 104, 106, 112, 116–118, 122, 124–126], 14 used levobupivacaine [37, 45, 63, 73, 78, 82, 83, 86, 87, 97, 109, 111, 115, 121] and 32 used ropivacaine [36, 38, 39, 49, 52, 53, 56, 60, 67, 74, 75, 80, 81, 84, 88, 92, 95, 96, 102, 105, 107, 108, 110, 113, 114, 119, 120, 123, 127–131]. Twenty‐three trials used lidocaine in the local anaesthetic admixture [33, 41, 44, 46–48, 50, 51, 57, 62, 64, 66, 69, 89, 90, 98, 99, 101, 104, 112, 113, 115, 124], while 15 added epinephrine to the local anaesthetic [41, 42, 44, 47, 48, 51, 57, 62, 66, 69, 89, 90, 112, 113, 124].…”

“…The network geometry for our two main outcomes was as follows. Eighty‐five trials with 5134 patients examined sensory block duration [33–39, 41–43, 45, 47, 48, 52, 55–59, 61, 63, 65, 67, 68, 70, 71, 73–111, 113–131] (Fig. 1).…”

“…Consequently, these arms yielded estimates from indirect comparisons only. Ninety‐three trials with 5668 patients examined motor block duration [32–43, 45, 48, 50–63, 65, 67, 68, 70–111, 113–131] (Fig. 2).…”

“…Thirty‐eight articles were peer‐reviewed and indexed trials [32, 34, 36–38, 42, 44, 53, 54, 58, 59, 63, 66, 69, 72, 75, 79, 81–84, 94, 96, 99, 102, 105, 107, 109, 110, 113–116, 123, 124, 127–129], while 62 articles were peer‐reviewed, non‐indexed publications [33, 35, 39–41, 43, 45–52, 55–57, 60–62, 64, 65, 67, 68, 70, 73, 74, 76–78, 80, 83, 85–93, 95, 97, 98, 100, 101, 103, 104, 106, 108, 111, 112, 117–122, 125, 126, 130, 131]. Fifty‐four trials used bupivacaine as their long‐acting local anaesthetic [32–35, 38, 40–44, 46–48, 50, 51, 54, 55, 57–59, 61, 62, 64–66, 68–72, 76, 77, 79, 85, 89–91, 93, 94, 98–101, 103, 104, 106, 112, 116–118, 122, 124–126], 14 used levobupivacaine [37, 45, 63, 73, 78, 82, 83, 86, 87, 97, 109, 111, 115, 121] and 32 used ropivacaine […”

Comparison of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

“…It adds to the quality of postoperative pain relief and patient satisfaction. 2 Bupivacaine is the most commonly used local anesthetic agent in our set up because of its free availability and longer duration of action. However, it has some disadvantages like slow onset, patchy effect and the potential to cause systemic toxicity due to possible intravascular injection of a large dose.…”