Efficacy of clonidine as an additive on the duration of action of brachial plexus block performed under ultrasound and nerve locator guidance: A prospective randomized study

Abstract

Background: Clonidine, an alpha 2 agonist, when added to local anesthetics in different regional and neuraxial blocks reduces the onset time, improves the efficacy, and increases the duration of postoperative analgesia. Aims: This study evaluated the effect of bupivacaine clonidine combination in ultrasound and nerve locator-guided supraclavicular brachial plexus block for upper limb surgeries. Settings and Design: This was a prospective, randomized, controlled, double-blind study carried out in a tertiary care center in South India on 50 patients with American Society of Anesthesiologists (ASA) physical status classes I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block. Materials and Methods: Eligible participants were randomized equally to either Group B who received 20 ml of bupivacaine and 7 mL of 2% lignocaine or Group C who received 20 ml of bupivacaine, 7 ml of 2% lignocaine, and 100 μg of clonidine. Statistical Analysis: Continuous outcome variables were tested for statistical significance using Student's t -test, and Mann–Whitney U-test was used for outcomes that were nonnormally distributed. Categorical variables were compared using Fisher's exact test. P <0.05 was considered as statistically significant. Results: The onset of sensory and motor blockade was significantly faster ( P < 0.05) in Group C compared to Group B. The duration of sensory and motor block and the duration of analgesia were significantly longer in Group C ( P < 0.001). The sedation in Group C patients was significantly more ( P < 0.05) when compared to Group B, but none of the sedation scores exceeded 3 on the Ramsay sedation score. Hemodynamic parameters did not differ between groups ( P > 0.05). Conclusion: The inclusion of 100 μg of clonidine with bupivacaine in ultrasound-guided supraclavicular brachial plexus blocks prolongs both sensory and motor blockade. It also provides significant postoperative analgesia and mild sedation which is beneficial in the immediate stressful postoperative period.

Robot-assisted radical prostatectomy: comparison of subarachnoid analgesia, erector spine plane block, and intravenous analgesia for postoperative pain management

“…Our results is in contrast with previous report which found no difference in NRS score in patients undergoing open radical prostatectomy treated with ESP block compared to placebo [19]. This discrepancy could be partly attributed to the different surgical approach as robot-assisted intervention is demonstrated to be less painful than open surgery; moreover we used clonidine and dexamethasone which both demonstrated a significant prolongation of analgesia in peripheral block [20,21].…”

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

“…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. Of note, the heterogeneity of nerve stimulation (single or multiple) or the dual ultrasound plus nerve stimulation-based block techniques used may have influenced the spread of the local anaesthetic within the brachial plexus sheath and the subsequent block characteristics.…”