Effects of clonidine added to mepivacaine axillary brachial plexus block for paronychia surgery

Iohom, Gabriella; Machmachi, A.; Diarra, D. P.; Khatouf, Mohammed; Boileau, S.; Dap, F.; Boini, Stéphanie; Mertès, Paul-Michel; Bouaziz, Hervé

doi:10.1097/00003643-200406002-00435

Cited by 2 publications

(4 citation statements)

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“…This study demonstrated that adding clonidine to lidocaine with epinephrine for ultrasound-guided axillary brachial plexus block resulted in shorter overall onset time, prolonged duration of both sensory and motor block, and prolonged duration of postoperative analgesia. Our results are similar to previous findings, whereby clonidine added to local anaesthetics in conventional axillary brachial plexus block shortened block onset time [ 9 , 10 , 11 , 12 ] and prolonged the duration of anaesthesia and analgesia following the conclusion of the blocks [ 9 , 10 , 11 , 12 , 13 , 14 ]. In contrast to earlier studies, we performed all of the blocks solely under ultrasound guidance, ensuring uniformity in the deposition of local anaesthetic around all four terminal nerves, thus minimising the differences associated with the technique.…”

Section: Discussionsupporting

confidence: 92%

“…They concluded that 30 to 90 µg clonidine improved the nerve block quality while limiting the side effects. Similarly, Iohom et al [ 11 ] demonstrated that the addition of clonidine to mepivacaine in an axillary brachial plexus block led to a decrease in sensory block onset time and an increase in the duration of anaesthesia and postoperative analgesia. More recently Hrishi et al [ 22 ] found that clonidine added to a mixture of bupivacaine and lidocaine shortened the onset time and prolonged the duration of ultrasound-guided supraclavicular block.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies have yielded conflicting results when clonidine, an α 2 -adrenergic agonist, was combined with local anaesthetics for the purpose of a peripheral nerve blockade. While several studies on brachial plexus block have demonstrated shorter block onset time and longer anaesthesia duration [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ], other studies have found contrasting results [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Ranganath

Hitka

Iohom

2021

JCM

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This study evaluated the effects of adding adjuvant clonidine to lidocaine with epinephrine on the characteristics of ultrasound-guided axillary brachial plexus block (ABPB) for upper extremity surgery. Twenty-four patients were randomised to receive an ultrasound guided ABPB with 20 mL of lidocaine 2% with 1:200,000 epinephrine plus 2 mL of either normal saline 0.9% (Group 1) or a mixture of clonidine 1 µg/kg and normal saline 0.9% (Group 2). The outcome measures that were recorded were the overall onset time and the duration of sensory and motor block. The median (IQR) overall onset time of sensory and motor block was significantly shorter in Group 2 vs. Group 1 (5 (5–7.5) min vs. 10 (8.8–12.5) min; p < 0.001) and (5 (2.5–7.5) min vs. 7.5 (6.3–7.5) min; p = 0.001), respectively. The median (IQR) overall duration of sensory and motor block was significantly longer in Group 2 vs. Group 1 (225 (200–231) min vs. 168 (148–190) min; p < 0.001) and (225 (208–231) min vs. 168(148–186) min; p < 0.001), respectively. In ultrasound-guided ABPB, the addition of clonidine to lidocaine with epinephrine resulted in shorter onset time and prolonged duration of sensory and motor block.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Ranganath

Hitka

Iohom

2021

JCM

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“…Several studies have demonstrated that the addition of clonidine to local anaesthetic in peripheral nerve blocks reduces postoperative pain and analgesic requirements and increases the duration of sensory nerve block. [1][2][3][4] The mechanism by which it prolongs local anaesthetic action remains unclear and several potential receptor and channel-mediated mechanisms have been postulated. [5][6][7][8][9] The site of action of clonidine in this setting is also unclear, with some previous studies supporting a central mechanism of action, 10,11 but others indicating that the likely site of action is peripheral at the nerve itself.…”

Section: Introductionmentioning

confidence: 99%

Adding low concentrations of clonidine to ropivacaine for transversus abdominis plane blocks does not reduce plasma ropivacaine levels, suggesting a lack of vasoconstrictor effect

Crawford

Loadsman

Yang

et al. 2019

Anaesth Intensive Care

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Clonidine has been used successfully to prolong the duration of action of local anaesthetics in peripheral nerve blocks, but its mechanism of action in this setting remains unclear. Some studies suggest that clonidine exerts a vasoconstrictor effect, limiting the washout of local anaesthetic from its site of deposition. We investigated this potential vasoconstrictor effect, using plasma ropivacaine concentrations as a surrogate measure of vasoconstriction, in patients who received transversus abdominis plane (TAP) blocks with and without clonidine. Eighty women undergoing laparoscopic gynaecological surgery were randomly assigned to receive one of four TAP block solutions: 0.2% ropivacaine (control), ropivacaine with clonidine 2 μg/kg (clonidine), ropivacaine with 1:400,000 adrenaline (adrenaline) or ropivacaine and a subcutaneous injection of clonidine 2 μg/kg (SC clonidine). The primary outcome was total venous plasma ropivacaine concentrations up to 6 h after the block. There were no significant differences in plasma ropivacaine concentrations between the control group and the clonidine group at any timepoint in the study, nor were there differences in either the mean maximum ropivacaine concentration ( Cmax) (1.99 μg/mL versus 2.05 μg/mL, P = 0.712) or the time to maximum concentration ( Tmax) (51.0 min versus 56.0 min, P = 0.537). The SC clonidine group also did not differ significantly from the controls ( Cmax 2.13 μg/mL versus 1.99 μg/mL, P = 0.424; Tmax 43.5 min versus 51.0 min, P = 0.201). Plasma ropivacaine concentrations in the adrenaline group were significantly lower than the controls from 10 to 90 min ( P < 0.003 for each comparison), and the Cmax was less than that of the control group (1.36 μg/mL versus 1.99 μg/mL, P < 0.001) with a longer Tmax (103.5 min versus 51.0 min, P = 0.001). These findings indicate that clonidine at a concentration of 1.35 μg/mL added to ropivacaine for TAP blocks did not produce a reduction in plasma ropivacaine concentrations. This suggests a lack of vasoconstrictor effect during TAP blocks. Further studies should evaluate whether vasoconstriction occurs when clonidine is used at higher concentrations or for other blocks.

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Effects of clonidine added to mepivacaine axillary brachial plexus block for paronychia surgery

Cited by 2 publications

References 0 publications

Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Adding low concentrations of clonidine to ropivacaine for transversus abdominis plane blocks does not reduce plasma ropivacaine levels, suggesting a lack of vasoconstrictor effect

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