Background and Objective: Various adjuvants are added to local anesthetic to prolong the duration and faster the onset time of sensory and motor block and increase the quality of various types of peripheral nerve blocks and in local infiltration also. Presented study was conducted in upper limb surgery to evaluate and compare the effect of addition of clonidine and dexmedetomidine in ropivacaine as an adjuvant.

Methodology: This prospective observational study was planned insixty ASA Grade I and II patients scheduled for upper limb surgeries under supraclavicular brachial plexus block and were randomly divided in to two equal groups, 30 patients in each. Group RC(n=30) received clonidine 1ug/kg (1ml) and Group RD(n=30) received dexmedetomidine 1ug/kg (1ml)added to ropivacaine 0.375 % (39 ml), total 40 ml volume was prepared and injected by using paresthesia with blind technique of supraclavicular block. Thereafter, onset time of sensory, motor block, duration of sensory, motor block, duration of analgesia, sedation score, grade of bleeding during surgery, systemic side effects and variation in hemodynamic parameters at different time intervals were studies in both the group.

Results: The duration of sensory and motor block and duration of analgesia was significantly prolonged in RD group as compare to RC group (p value 0.001) but there was no statistically significant difference in onset of sensory and motor block between two groups and sedation score was better in RD group as compare to RC group.

Conclusion: Dexmedetomidine is better adjuvant compare to clonidine added to ropivacaine 0.375% in supraclavicular brachial plexus block enhanced the duration analgesia, sensory and motor block and also quality of anesthesia.

Keywords: Supraclavicular block, Dexmedetomidine, Clonidine, Ropivacaine.

1. http:www.nysora.com/techniques/nerve-stimulator-and-surface-based-ra-techniques/upper-extremitya/index.1.html.
2. Sahu D,Sahu A. Lateral approach for supraclavicular brachial plexus block. Indian J Anaesth.2015;54:215-8.
3. Rettig HC, Gielen MJ, Boersma E, Klein J. A comparison of vertical infraclavicular and axillary approaches for brachial plexus anesthesia. Acta Anaesthesiol Scand.2005;49:1501-8.
4. Ertuz Z, Yegin A, Ertem S, Sahin N, Hadimioglu N,Dosemeci L.et al. Comparison of two different technique for brachial plexus block:-Infraclavicular vs axillary technique. Acta Anaesthesiol Scand.2005;49:1035-9.
5. Stiles P, Prielipp. (springs 2009). Anesthesia patients safety foundation.2013:24;(1)
6. Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth 2011;55: 104-10.
7. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, etal. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth 2011;55:116-21
8. Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: A systematic review. Anesth Analg 2000; 90:1122-8.]
9. Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders; 1978: 144
10. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxolone-alphadolone. Br Med J. 1974 Jun 22;2(5920):656-9
11. Boezaart AP, van der Merwee J, Coetzee A. Comparison of sodium nitroprusside and esmolol induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995 May; 42:373–376.
12. Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (a2 agonist drugs) as an adjuvant to local anaesthesia in supraclvicular brachial plexus block: A randomized double-blind prospective study. Indian J Anaesth. 2012 May;56(3):243-9. doi: 10.4103/0019-5049.98767
13. Jinjil K, Bhatnagar V, Swapna P, Tandon U. Comparative evaluation of Alpha two agonists dexmedetomidine with clonidine as adjuvants to 0.25% ropivacaine for ultrasound guided supraclavicular block: A randomized double-blind prospective study. Int J. of Healthcare and Biomedical Research 2015; 03(3): 20-31
14. Manpreet K, P.M. Singh. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essay res.2011; 5(2)
15. Gabriel JS, Gordin V. Alpha 2 agonists in regional anesthesia and analgesia. Curr Opin Anaesthesiol. 2001; 14:751–3.
16. Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: A volunteer study. Br J Anaesth. 2013; 110:438–42.
17. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008;107: 96–101.
18. Singh S, Aggarwal A. A randomized controlled double blinded prospective study of the efficacy of clonidine added to bupivacaine as compared with bupivacaine alone used in supraclavicular brachial plexus block for upper limb surgeries Indian J Anaesth 2010; 54:552-557.
19. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010; 111:1548-1551
20. Qazi Ehsan Ali, Manjunatha, Abdul Quadir. Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: a prospective study. Indian journal of anesthesia. 2014;58(6):709-713.
21. Tripathi A, Sharma K, Somvanshi M, Samal RL. A comparative study of clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular block. J Anaesthesiol Clin Phamacol.2016;32(3):344-348.
22. Hunter JC, Fontana DJ, Hedley LR, Jasper JR, Lewis R, Link RE, et al. Assessment of the role of alpha 2-adrenoceptor subtypes in the antinociceptive, sedative and hypothermic action of dexmedetomidine in transgenic mice. Br J Pharmacol. 1997 Dec;122 (7):1339–1344.
23. Durmus M, But A K, Dogan Z, Yucel A, Miman M C, Ersoy M O. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol. 2007 May;24(5):447-453. 
24. Marchal JM, Gomez-Luque A, Martos-Crespo F, Sánchez De La Cuesta F, Martínez-López MC, Delgado-Martinez AD. Clonidine decreases intraoperative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand. 2001;45(5):627–63
25. Seema Shende, Nupur Chakravarty, Shiv Kumar Raghuwanshi, Ramchandra Vinayak Shidhaye. Comparison of dexmedetomidine and clonidine as an adjuvant to lignocaine with adrenaline in infiltration anesthesia for tympanoplasty. Anesthesia pain and intensive care.2016.

Dr Kamlesh K Shekhawat

Assistant Professor, Department of Anesthesia, Critical Care and Pain, Pacific Institute of Medical Sciences, Ambua Road, Village Umarda, Girwa, Udaipur-313015, Rajasthan, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.