International Journal of Medical and Dental Sciences

Open Access Open Access  Restricted Access Subscription Access

Dexmedetomidine as an Adjuvant to Levobupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block


Affiliations
1 Department of Anesthesiology, People's College of Medical Sciences & Research Centre, Bhopal - 462037, India
2 Department of Anesthesiology, SHKM GMC Nalhar Mewat Haryana, India
3 Department of Anatomy, SGT Medical College, Gurgaon, India
 

Background:Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks.

Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia.

Material and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325%levobupivacaine + 1μg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded..

Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p < 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups.

Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.


Keywords

Adjuvant, Dexmedetomidine, Supraclavicular Brachial, Plexus Block, Levobupivacaine.
User
Notifications
Font Size


  • Singelyn FJ, Dangoisse M, Bartholomee S, Gouverneur JM. Adding clonidine to mepivacaine prolongs the duration of anesthesia and anesthesia after brachial plexus block. Reg Anesth 1992;17:148-50.

  • Duma A, Urbanek B, Sitzwohl C, Kreiger A, Zimpfer M, Kapral S. Clonidine as an adjuvant to local anaesthetic axillary brachial plexus block: A randomized, controlled study. Br J Anaesth 2005; 94:112-6.

  • Popping DM, Elia N, Marret E, Wenk M, Tramer MR. Clonidine as an adjuvant to local anaesthetic for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology 2009;111:406-15.

  • Virtanen R, Savola JM, Saano V, Nyman L. Characterisation of selectivity, specificity and potency of medetomidine as an alpha 2- adrenoceptor agonist. Eur J Pharmacol 1988;150:9-14.

  • Abosedira MA. Adding clonidine or dexmedetomidine to lignocaine during Biers block: A comparative study. J Med Sci 2008;8:660-4.

  • Esmaoglu A, Mizrak A, Akin A, Turk Y, Boyaci A. Addition of dexmedetomidine to lidocaine for intravenous regional anesthesia. Eur J Anaesthesiol 2005;22:447-51.

  • Mantz J, Singer M. Importance of patient orientation and rousability as components of intensive care unit sedation. In: Maze M, Morrison P, editors. Redefining Sedation. London: The Royal Society of Medicine Press Ltd; 1998.p.23-9.

  • Shehabi Y, Ruettimann U, Adamson H, Innes R, Ickeringill M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: Sedative and cardiovascular effects. Intensive Care Med 2004;30:2188-96.

  • Shukry M, Miller JA. Update on dexmedetomidine: Use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag 2010;6:111-21.

  • Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, AlYaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anesthesiol Scand 2006;50:222-7.

  • Konakci S, Adanir T, Yilmaz G, Rezanko T. The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route. Eur J Anaesthesiol 2008;25:403-9.

  • Yazbek-Karam VG, Aouad MA.Perioperative uses of dexmedetomidine.Middle East J Anesthesiol 2006;18:1043-58.

  • El-Hennawy AM, Abd-Elwahab AM, AbdElmaksoud AM, El-Ozairy HS, Boulis SR.Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009;103:268-74.

  • Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added tolevobupivacaine prolongs axillary brachial plexus block. Anaesth Analg 2010;111:1548-51.

  • Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol 2010;27:280-4.

  • Rancourt MP, Albert NT, Cote M, Letourneau DR, Bernard PM. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesth Analg 2012;115:958-62.

  • 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;56:243-9.

  • Sarkar DJ, Khurana G, Chaudhary A, Sharma JP. A comparative study on the effects of adding fentanyl and buprenorphine to local anaesthetica in brachial plexus block. J Clin Diagn Res 2010;4:3337-43.

  • Ramsay MA, Savage TM, Simpson BR, Goodwin R. Controlled sedation with alphaxolone-alphadolone. Br Med J 1974;2:656-9.

  • Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A review of clinical applications. Curr Opin Anaesthesiol 2008;21:457-61.

  • Hall JE, Uhrich TD, Barney JA, Arain SA, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.

  • Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 1996; 84:873-81.

  • Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology 2008;109:502-11.

  • Brummett CM, Amodeo FS, Janda AM, Padda AK, Lydic R. Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block. Reg Anesth Pain Med 2010;35:427-31.

  • Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyper polarization-activated cation current. Anesthesiology 2011;115:836- 43.

  • Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potentials in frog sciatic nerve without alpha(2) adrenoceptoractivation. Br J Pharmacol 2010;160:1662-76.

  • 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.

  • Amany S Ammar, Khaled M Mahmoud. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi J Anaesth 2012 Apr-Jun;6(2):109-14.

  • Memis D, Turan A, Karamanlioglu B, Pamukcu Z, Kurt I. Adding dexmedetomidine to lignocaine for IVRA. Anesth Analg 2004;98:835-40.

  • Merle N Tandoc, Liang Fan, Sergei Kolesnikov, Alexander Kruglov, Nader D. Adjuvant dexamethasone with bupivacaine prolongs the duration of inter scalene block: a prospective randomized trial. Journal of Anesthesia October 2011;25:704-9.

  • Masuki S, Dinenno FA, Joyner MJ, Eisenarch JH. Selective alpha 2adrenergic properties of dexmedetomidine over clonidine in the human forearm. J Appl Physiol 2005; 99:587-92.


Abstract Views: 264

PDF Views: 155




  • Dexmedetomidine as an Adjuvant to Levobupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

Abstract Views: 264  |  PDF Views: 155

Authors

V. Waindeskar
Department of Anesthesiology, People's College of Medical Sciences & Research Centre, Bhopal - 462037, India
K. Bhatia
Department of Anesthesiology, SHKM GMC Nalhar Mewat Haryana, India
S. Garg
Department of Anatomy, SGT Medical College, Gurgaon, India
J. Kumar
Department of Anesthesiology, People's College of Medical Sciences & Research Centre, Bhopal - 462037, India
S. Songir
Department of Anesthesiology, People's College of Medical Sciences & Research Centre, Bhopal - 462037, India
V. Singla
Department of Anesthesiology, SHKM GMC Nalhar Mewat Haryana, India

Abstract


Background:Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks.

Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia.

Material and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325%levobupivacaine + 1μg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded..

Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p < 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups.

Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.


Keywords


Adjuvant, Dexmedetomidine, Supraclavicular Brachial, Plexus Block, Levobupivacaine.

References





DOI: https://doi.org/10.18311/ijmds%2F2016%2F100605