To Compare and Evaluate the Effect of Dexmedetomidine as an Adjuvant to Local Anaesthetic Agents in Supraclavicular Brachial Plexus Block for Elective Forearm Surgery

Abstract

A variety of receptor mediated nociception on peripheral sensory axons and the peripheral administration of appropriate drugs (adjuncts) may have analgesic benefit without the disadvantage of systemic adverse effects and it may also allow reduction in the total dose of local anaesthetic used. Recent studies suggest that α2 agonists when combined with local anaesthetics extends the duration of regional anaesthesia. Thus, in the present study, we investigated the effects of adding dexmedetomidine 50 µg to a 30 mL of local anaesthetic solution in supraclavicular brachial plexus block with respect to onset and duration of motor and sensory block and duration of analgesia. METHODSSixty patients scheduled for elective forearm surgery were divided into two equal groups in a randomised double blind fashion. In group C (n=30), 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+0.5 mL of normal saline and in group D (n=30) 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+50 µg dexmedetomidine were given for supraclavicular brachial plexus block using peripheral nerve stimulator. Onset and duration of sensory and motor block were assessed along with total duration of analgesia. Demographic and haemodynamic data were subjected to student's t-test and for statistical analysis of onset time and duration of sensory and motor blocks and total duration of analgesia, unpaired t-test was applied. P-value <0.05 was considered as statistically significant and P-value <0.001 as highly significant. RESULTSDexmedetomidine added as an adjuvant to local anaesthetic agents for supraclavicular block shortens onset time and significantly prolongs the duration of sensory and motor blocks and duration of analgesia.

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

“…For motor block duration, 23 studies were judged to be at low risk of bias [32, 35, 38, 39, 42, 45, 53, 54, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 67 studies were at some risk of bias [33, 34, 36, 37, 40, 43, 48, 50–52, 55, 57, 58, 60–62, 67, 68, 70–75, 77–80, 83–91, 95–106, 108, 109, 111, 114, 117–126, 128–131] and 3 studies were at high risk of bias [41, 63, 127]. The provision of inadequate detail about randomisation and allocation concealment was the most common reason for downgrading the rating, followed by concerns relating to outcome measurement.…”

“…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 […”

“…For the primary outcome, sensory block duration, 20 studies were judged to have a low risk of bias [35, 38, 39, 42, 45, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 61 studies had some risk of bias [33, 34, 36, 37, 43, 47, 48, 52, 55, 57, 58, 61, 67, 68, 70, 71, 73–75, 77–80, 83–85, 87–91, 95–106, 108, 109, 111, 114, 117–123, 125–131] and 4 studies were at high risk of bias [41, 63, 86, 124].…”

“…The full‐text manuscripts of the remaining 312 studies were assessed. After including studies from hand searches and revision of search, we identified a total of 100 studies for inclusion in this network meta‐analysis [32–131]. The study flow chart is in online Supporting Information Figure S1.…”

“…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).…”