Research Article

Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Brachial Plexus Block Using Supraclavicular Parasagittal Approach for Upper Limb Orthopedic Surgeries

Abstract

Background: Brachial plexus block is a key technique in anesthesiologist’s practice. Ropivacaine is a long acting local anaesthetic, Dexmedetomidine has been included as an adjuvant to enhance block duration.
Aim: To elucidate the effect of addition of Dexmedetomidine to Ropivacaine in ultrasound guided parasagittal supraclavicular brachial plexus approach with respect to duration of analgesia, onset and duration of sensorimotor blockade.
Methods: A randomized single blinded prospective clinical study was conducted among Forty patients of 20-50yrs, ASA Grade I and II, weighing >60kgs scheduled for elective upper limb orthopedic surgeries. Group RN received 25ml of 0.75% ropivacaine with 1ml normal saline, Group RD received 25ml of 0.75% ropivacaine with 1mcg/kg dexmedetomidine diluted to 1ml. Analgesic efficacy, sensorimotor blockade was determined.
Statistical Analysis: Demographic and hemodynamic data was analyzed using student t-test. Unpaired t-test was used to analyze onset, duration of sensorimotor blockade and analgesic duration. Results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant.
Results: Analgesic duration was prolonged in Group RD rather than Group RN (646.82 +/- 21.56min vs 484.78 +/- 15.52min). Group RD had rapid onset of sensory (7.4 +/- 1.02min vs 9.9 +/- 1.16min) and motor blockade (10.25 +/- 1.13min vs 13.28+/- 1.22min). Duration of sensory (536.62 +/- 9.61min vs 413.79 +/- 15.61min) and motor blockade (430.13 +/- 11.68min vs 298.12 +/- 15.36min) was enhanced in Group RD.
Conclusion: Adding Dexmedetomidine to Ropivacaine provided superior analgesia along with rapid onset and longer duration of sensorimotor blockade.

[1] Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015; 9(2):148-54.
[2] Searle A, Niraj G. Ultrasound‑guided brachial plexus block at the supraclavicular level: A new parasagittal approach. Int J Ultrasound Appl Technol Perioper Care. 2010; 1:19-2
[3] Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011 ;55(2):104-10.
[4] Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study. Indian J Anaesth 2012; 56(3):243-9.
[5] Raeder JC, Drøsdahl S, Klaastad Ø, Kvalsvik O, Isaksen B, Strømskag KE, et al. Axillary brachial plexus block with ropivacaine 7.5 mg/ml: A comparative study with bupivacaine 5 mg/ml. Acta Anaesthesiol Scand. 1999; 43(8):794-8.
[6] Rashmi HD, Komala HK. Effect of dexmedetomidine as an adjuvant to 0.75% ropivacaine in interscalene brachial plexus block using nerve stimulator: a prospective, randomized double-blind study. Anesth Essays Res. 2017; 11(1):134-139.
[7] Jung HS, Seo KH, Kang JH, Jeong JY, Kim YS, Han NR. Optimal dose of perineural dexmedetomidine for interscalene brachial plexus block to control postoperative pain in patients undergoing arthroscopic shoulder surgery: A prospective, double-blind, randomized controlled study. Medicine. 2018; 97(16):e0440.
[8] Sinha C, Kumar A, Kumari P, Singh AK, Sharma S, Kumar A, et al. Comparison of two doses of dexmedetomidine for supraclavicular brachial plexus block: A randomized controlled trial. Anesth Essays Res. 2018; 12(2):470-4.
[9] Nallam SR, Chiruvella S, Karanam S. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial. Indian J Anaesth. 2017; 61(3):256-261.
[10] Zhang Y, Wang CS, Shi JH, Sun B, Liu SJ, Li Pet al. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block. Int J Clin Exp Med. 2014; 7(3):680-5.
[11] Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, et al. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med. 2014; 39(1):37-47.
[12] Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine. 2018; 97(41):e12573.
[13] Liu Z, Jiang M, Xu T, Hua H. Analgesic effect of Ropivacaine combined with Dexmedetomidine on brachial plexus block. BMC anesthesiology. 2018;18(1):107.
[14] Bangera A, Manasa M, Krishna P. Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block: A prospective randomized double-blinded clinical trial. Saudi J Anaesth. 2016; 10(1):38-44.
[15] Koraki E, Stachtari C, Kapsokalyvas I, Stergiouda Z, Katsanevaki A, Trikoupi A. Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound‐guided axillary brachial plexus block. Journal of clinical pharmacy and therapeutics. 2018; 43(3):348-52.
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IssueVol 8 No 3 (2022): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v8i3.9616
Keywords
Dexmedetomidine Ultrasound Supraclavicular brachial plexus block Ropivacaine Parasagittal
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How to Cite
1.
Balakrishnaiah M, Sheshadri K, Ramegowda S, Hosalli S, Kumar K, Ahmed S. Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Brachial Plexus Block Using Supraclavicular Parasagittal Approach for Upper Limb Orthopedic Surgeries. Arch Anesth & Crit Care. 2022;8(3):230-235.