Effect of locally administered dexmedetomidine as adjuvant to levobupivacaine in supraclavicular brachial plexus block: Double-blind controlled study

Abstract

Context:Brachial plexus block is effective with good postoperative analgesia in upper limb surgery has gained importance as it safe, low cost, and maintains stable hemodynamics intraoperatively. To decrease the onset time and prolong the duration of nerve block bicarbonate, opioids (morphine, fentanyl, etc.), sympathomimetic agents (epinephrine, phenylephrine, etc.), α-2 agonists (clonidine and dexmedetomidine), calcium channel blocker (verapamil), magnesium sulfate, etc., were studied with local anesthetics and their isomers. For their sedative, analgesic, perioperative sympatholytic, and cardiovascular stabilizing effects with reduced anesthetic requirements, α-2 adrenergic receptor agonists, such as more potent and highly selective dexmedetomidine, have been the focus of interest for regional anesthesia. Intravenous dexmedetomidine infusion resulted in significant opioid-sparing effects as well as a decrease in inhalational anesthetic requirements. Animal studies proved that dexmedetomidine enhances sensory and motor blockade along with increased duration of analgesia. In humans, dexmedetomidine has also shown to prolong the duration of block and postoperative analgesia when added to local anesthetic in various regional blocks. Bupivacaine, the widely used local anesthetic in regional anesthesia, is available in a commercial preparation as a racemic mixture (50:50) of its two enantiomers: levobupivacaine, S (−) isomer and dextrobupivacaine, R (+) isomer. Severe central nervous system and cardiovascular adverse reactions reported in the literature after inadvertent intravascular injection or intravenous regional anesthesia have been linked to the R (+) isomer of bupivacaine. The levorotatory isomers were shown to have a safer pharmacological profile with less cardiac and neurotoxic adverse effects. The decreased toxicity of levobupivacaine is attributed to its faster protein binding rate. The pure S (−) enantiomers of bupivacaine, i.e., ropivacaine and levobupivacaine were thus introduced into the clinical anesthesia practice. Such an increased usage mandates the documentation of evidence-based literature with regard to risk and safety concerns as well as clinical issues related to levobupivacaine. This study is designed to assess the efficacy of adding dexmedetomidine to levobupivacaine during placement of supraclavicular brachial plexus blockade.Materials and Methods:This prospective observational double-blinded study was conducted over a 1-year period among randomly selected seventy (n = 35) American Society of Anesthesiologists Classes I and II patients of ages between 18 and 60 years of both sexes scheduled to undergo upper limb surgery. With nerve locator, levobupivacaine (0.5%) 28 ml and 2 ml normal saline for Group L and levobupivacaine (0.5%) 28 ml and 0.75 μg/kg dexmedetomidine made up a solution of 2 ml, for Group D, a total 30 ml will be injected locally, in both the groups. Onset and duration of sensory and motor block will be assessed.Results and Discussion:One patient in Group L and two patients ...

Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block

“…Similar to our findings, previous two randomized double-blinded trials by Bisui et al and Kaur et al and a meta-analysis done by Abdallah and Brull showed that the addition of dexmedetomidine to local anesthetic in the brachial plexus block was reported to shorten the onset time of the sensory block [ 15 - 17 ]. Adinarayanan et al used a control group with the dexmedetomidine and dexamethasone groups [ 18 ], whereas Singh et al compared dexmedetomidine and dexamethasone in the brachial plexus block under ultrasound guidance [ 19 ].…”

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

“…Across all included studies, a total of 3332 patients were assessed. DEX was used as an adjuvant to several different local anesthetics, which included ropivacaine [ 23 , 34 , 39 , 41 , 42 , 45 – 47 , 49 , 50 , 52 , 56 , 57 , 59 , 63 – 66 , 68 , 72 – 74 , 76 , 78 , 80 , 81 , 84 , 85 ], bupivacaine [ 20 , 35 , 37 , 38 , 40 , 51 , 53 – 55 , 67 , 69 , 71 ], levobupivacaine [ 21 , 43 , 44 , 48 , 60 – 62 , 79 , 83 ], and lidocaine [ 22 , 36 , 70 , 77 , 86 ]. Across the studies, the dose of DEX ranged from 0.5 μg/kg to a total of 150 μg.…”

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”