A COMPARATIVE EVALUATION OF THE ADDITION OF CLONIDINE AND DEXMEDETOMIDINE TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB ORTHOPAEDIC SURGERIES

Dr Vandana Chugh; Dr Shakti Singhal; Dr Deepak Bhasin

Volume : VII, Issue : IV, April - 2018

A COMPARATIVE EVALUATION OF THE ADDITION OF CLONIDINE AND DEXMEDETOMIDINE TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB ORTHOPAEDIC SURGERIES

Dr Vandana Chugh, Dr Shakti Singhal, Dr Deepak Bhasin

Abstract :

Background: Adjuncts to local anaesthetics for achial plexus block may enhance the quality and duration of analgesia. Clonidine, an Alpha–2 adrenergic agonist, is known to produce antinociception and enhance the effect of local anaesthetics when given epidurally, intrathecally or in various peripheral nerve blocks. Levobupivacaine is a local anaesthetic drug belonging to amino amide group. It is the s.enantiomer of bupivacaine. Levobupivacaine has a greater margin of clinical safety with respect to both CVS AND CNS effects as compared to racemic bupivacaine. Dexmedetomidine, a selective α2–adrenoceptor agonist, has been used as an adjuvant during regional and local anesthesia. Objective:We conducted this study to assess the effect of Clonidine or dexmedetomidine, added to Levobupivacaine in achial plexus block by supraclavicular approach. The endpoints were evaluation of onset, duration of sensory and motor block and duration of analgesia. Methods:A prospective, randomized, single blinded study was conducted on total n=60 American Society of Anaesthesiologists (ASA) I or II adult patients undergoing upper limb surgeries under supraclavicular achial plexus block. Patients were randomly divided into three groups. Patients in first group L(n = 20) were administered 29mL of 0.5% Levobupivacaine (L) plus 1 ml NS and second group L+C (n= 20) were given 29mL of 0.5% levobupivacaine (L) with clonidine (C) 1μg/kg. And group L+D (n=20) were given 29 ml of 0.5% levobupivacaine with dexmedetomidine (D) 1μg/kg. The onset time and duration of sensory and motor blockade were recorded. Haemodynamic variables (i.e., heart rate, noninvasive blood pressure, and oxygen saturation), sedation scores and rescue analgesic requirements were recorded for 24 hrspostoperatively.Results:The onset of sensory and motor block was significantly faster in Group L+D compared to Group L+C and L (P < 0.05). Rescue analgesic requirements were significantly less in Group L+D compared to Group L+C and L (P < 0.05). Haemodynamics and sedation scores did not differ between groups in the post–operative period.Conclusion:Dexmedetomidine(1μg/kg) in combination with 29mL of levobupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in achial plexus block, without producing any adverse events.