Effect of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A randomized double-blind prospective study

Abstract

Background and Aims:Regional anesthesia is a recommended technique for upper and lower limb surgeries with better postoperative profile. In this, randomized, double-blind study, we evaluated the effectiveness of the addition of dexmedetomidine to varying concentration of levobupivacaine for supra clavicular brachial plexus block.Material and Methods:After obtaining ethical Committee approval, a double-blind, randomized prospective clinical study was conducted on 90 American Society of Anesthesiologist Grade I and II patients in the age group of 18-55 years, divided randomly into two groups: Group A received 40 ml of solution containing 30 ml 0.5% levobupivacaine and 10 ml 1% lignocaine and group B received 40 ml of solution containing 30 ml 0.25% levobupivacaine and 10 ml 1% lignocaine with dexmedetomidine 1 microg/kg for supraclavicular brachial plexus block. Besides effectiveness, other parameters observed were: duration of sensory blockade; onset and duration of motor blockade; duration of postoperative analgesia; and patient satisfaction score.Results:Onset of sensory and motor blockade was 7.6 ± 1.006 min and 8.3 ± 0.877 min in group A, while it was 6.96 ± 1.077 min an 7.6 ± 1.1 min in group B, respectively. The difference was statistically significant (P < 0.05). Duration of sensory block was 8.5 ± 0.77 h in group A and 8.5 ± 0.98 in group B (P > 0.05). Duration of motor block was 8.45 ± 0.75 h in group A and 5.6 ± 0.98 in group B (P < 0.05). Duration of analgesia was 8.5 ± 0.77 h in group A and 9.2 ± 1.05 in group B (P < 0.05).Conclusion:Addition of 1 microg/kg dexmedetomidine to 0.25% levobupivacaine for supraclaviclar plexus block shortens sensory, motor block onset time and motor block durations, extends sensory block, and analgesia durations. Reduction in total levobupivacaine dose also increases the safety margin of the block.

Investigating the Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthesia in Brachial Plexus Block

“…In regard to the type of brachial plexus block used, a total of 10 studies utilized a supraclavicular block, 4,15,18,19,[22][23][24][25]27,30 3 used an axillary block, 20,26,29 3 used an interscalene block, 14,17,21 and 2 used an infraclavicular block. 16,28 Dexmedetomidine was used as an adjuvant to several different local anesthetics, which included levobupivacaine, 17,18,20,25,28 ropivacaine, 14,19,21,23,24,27,29,30 bupivacaine, 4,15,16,22 and mepivacaine. 28 Across the studies, the dose of dexmedetomidine ranged from 0.5 μg/kg to a total of 150 μg.…”

“…Studies were grouped according to dosage of dexmedetomidine. Doses greater than 50 μg 4,14,16,19,20,[25][26][27] led to a significant reduction in sensory block onset time (MD, −2.61 minutes; 95% CI, −3.93 to −1.30 minutes; I 2 = 94%; P < 0.0001); however, no significance was observed at doses 50 μg or less 17,[22][23][24]29 (MD, −5.07 minutes; 95% CI, −11.93 to 1.78 minutes; I 2 = 96%; P = 0.15). The data were also stratified according to location of the overall block.…”

“…The data were also stratified according to location of the overall block. Dexmedetomidine, when given as an adjuvant for supraclavicular 4,15,19,[22][23][24][25]27 (MD, −3.20 minutes; 95% CI, −5.13 to −1.27 minutes; I 2 = 96%; P =0.001), infraclavicular 16 (MD, −6.20 minutes; 95% CI, −7.45 to −4.95 minutes; I 2 = N/A; …”

“…The addition of dexmedetomidine significantly prolonged duration of sensory blockade irrespective of the dosage (≤50 μg [22][23][24]29 or >50 μg 4,15,16,18-20,25-28 ), location of block (eg, supraclavicular, 4,15,18,19,[22][23][24][25]27 infraclavicular, 16,28 or axillary 20,26,29 ), or the local anesthetic given (eg, ropivacaine, 19,23,24,27,29 bupivacaine, 4,15,16,22 levobupivacaine, 18,20,25,26 or mepivacaine 28 ).…”

“…The data were also stratified according to location of the overall block. The addition of dexmedetomidine significantly reduced motor block onset time in comparison to control regardless of the location (eg, supraclavicular, 4,15,19,[22][23][24][25]27 infraclavicular, 16,28 or axillary 20,26,29 ). Finally, when the data were stratified according of local anesthetic given, it was found that dexmedetomidine led to significantly reduced motor block onset times when given as an adjuvant to ropivacaine 19,23,24,27,29 (MD, −6.49 minutes; 95% CI, −11.28 to −1.71 minutes; I 2 = 94%; P = 0.008) and levobupivacaine 20,25,26 (MD, −1.16 minutes; 95% CI, −1.91 to −0.41 minutes; I 2 = 69%; P = 0.002); however, no significant difference was observed when dexmedetomidine was given with bupivacaine 4,15,16,22 in comparison to control (MD, −2.32 minutes; 95% CI, −6.95 to 2.31 minutes; I 2 = 98%; P = 0.33).…”