Title: Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to 0.25% Bupivacaine in Supraclavicular Brachial Plexus Block
Authors: Bharat Kumar, Vaijayanti Gadre, Padara Basavaraj
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.221
Abstract
Introduction: relief of intra and post operative pain has gained importance in recent years. Nerve blocks from the cornerstone in this arena. Brachial plexus block is a commonly used technique for majority of upper limb surgeries.
Aim: To evaluate the effect of dexmedetomidine and fentanyl as an adjuvant to low dose bupivacaine 0.25% in terms of onset, duration, and quality of sensory and motor block when used for supraclavicular brachial plexux block.
Materials and Methods: after the approval of ethical committee, 80 ASA grade I and II patients of either sex, between 18-60 years of age undergoing orthopaedic and plastic surgeries under supraclavicular block were studied after randomly assigning them into two groups of 40 each.
Group D: Bupivacaine 0.25% (34 ml) +dexmedetomidine 1 microgm/kg
Group F : Bupivacaine 0.25% (34 ml) +fentanyl 1 microgm/kg
After baseline investigations and preoperative routine assessment, the consenting patients were premedicated with inj midazolam 0.03 mg/kg and inj glycopyrrolate 5 microgm per kg Iv 10 minutes prior to surgery after putting ECG,NIBP ,SPO2 monitors and securing 18 G IV cannula in the non operative upper limb. Block was given using paresthesia technique. Onset ,duration and quality of both sensory and motor block in either group were studied .use of rescue analgesia in both the groups in post operative period was compared up to 24 hours.
Results: onset of both sensory and motor block was faster, 2.95 +/- 0.0693 minutes in group D versus 4.275+/-0.933 minutes in group F ; and 5.45+/-0.86 minutes in group D versus 6.025+/-0.861 minutes in group F respectively; total duration of block was prolonged, 608+/- 38.84 minutes in group D and 383+/-27.66 minutes in group F
Conclusion: dexmedetomidine is superior to fentanyl as an adjuvant to low dose bupivacaine for supraclavicular brachial plexus block.
Keywords: dexmedetomidine, fentanyl, pain relief, nerve blocks, supraclavicular block.
References
- Damien B, Muhy, Collin JL, Cartney, Vincent WS ,Novel analgesic adjuvants for brachial plexus block; A systemic review. Anesth Analg 2000;90:1122-8
- Lennart Christiansson. Update on adju-vants in regional anaesthesia. Periodicum biologorum.2009;111(2);161-170
- Ghanshyam Biyani , Anjolie Chhabra, Dalim Kumar Baidya, Rahul Kumar Anand. Adjuvants to local anaesthetics in regional anaesthesia -should they be used ? part I .Pros .Trends in Anaesthesia and critical care 4 . 2014;19-24
- Sarita SS ,Keniya VM, Ladi SD, ,Rao R. comparison of dexmedetomidine and clonidine (alpha -2 agonist) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block ; A randomiosed double blind prospective study. Indian J A naesthesiology 2012 may ;56(3) ;243-9
- Harshwardhana HS, Efficacy of dexmedetomidine compared to clonidine added ropivacaine in supraclavicular nerve blocks : A prospective Randomised Double Blind Study .Int J Med Health A pril 2014; 3(2): 127-132
- Keshav Govind rao , pawan Kapoor, Manoj Kumar chaurasiya and Aparna Shukla. A randomised controlled study to compare clonidine and dexmedetomidine as an adjuvant in supraclavicular brachial plexus block.Indian J of Fundamental and Applied Life Sciences 2014;4(1) : 226-229
- Siamak Yaghoobi, Mahyar seddighi, Zohreh Yazdi Razieh Ghafouri , and Marzieh Beigom Khezri . comparison of postoperative analgesic effect of dexamethasone and fentanyl added to lidocaine through axillary block in forearm fracture. Hindwai publishing corporation pain research and treatment volume 2013, Article ID 761583
- Kenan Kaygusuz., Iclal Ozdemir Kol , Cevdet Duger, Sinan Gursoy, Hayati Ozturk, Ulku Kaycan, Rukiye Aydin and Caner Mimaroglu. Effect of adding Dexmedetomidine to levobupivacaine in axillary brachial plexus block . Current Thes Res Clin Exp .2012;73: 103-111
- Gandhi R, Shah A, Patel I .Use of dexmedetomidine along with bupivacaine for brachial plexus block. National J med Res 2012;2:67-9
- Esmaoglu A , Yegenglu F , Akin A , Turk C. dexmedetomidine added to levobupi-vacaine prolongs axillary brachial plexus block. Anaesth Analg 2010;111:1548-51.