Research Article

The Block Facilitatory Effects of Perineural Dexmedetomidine in Supraclavicular Brachial Plexus Block with Ropivacaine: Does Dexmedetomidine Has Perineural Site of Action? A Randomized, Controlled and Triple Blind Study

Abstract

Background: Although nerve block facilitatory effects of dexmedetomidine when used as a perineural adjunct to local anesthetics in supraclavicular brachial plexus blocks are well recognized in multiple studies, but whether this action is at directly on peripheral nerve fibers or is at central level after systemic absorption is unclear. Aim of this study was to evaluate the effect of adding dexmedetomidine 1 microgram/kg to ropivacaine 0.5% in supraclavicular brachial plexus block in terms of duration of analgesia and 24hour cumulative analgesic requirement and to test the hypothesis whether the effect of dexmedetomidine, is due to direct local action on nerve plexus or is centrally mediated after systemic absorption.
Methods: 105 patients of ASA grade I and II of either sex undergoing upper limb orthopedic surgeries were divided in 3 groups of 35 patients in each group. Group Rc (control group) received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline; group RDexP received supraclavicular block with 30ml solution of 0.5% ropivacaine+ dexmedetomidine 1mcg/kg and intravenous infusion of 30ml of normal saline; and group RDexIV received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline solution containing dexmedetomidine 1mcg/kg. Primary outcome was duration of analgesia and 24hour cumulative analgesic requirement.
Results: The demographic data were comparable in all three groups. Duration of analgesia was longest in group RDexP followed by group RDexIV and least in control group. 24hour cumulative analgesic requirement was least in group RDexP and maximum in group R. 2 patients, one from each group RDexP and group RDexIV reported bradycardia and 6 patients from group RDexIV reported hypotension.
Conclusion: We conclude that action of dexmedetomidine is most probably peripheral on brachial plexus nerve fibers directly rather than centrally mediated after systemic absorption.

[1] Hadzic A, Vloka JD, editors. Halstead. Peripheral Nerve Blocks: Principles and Practice. New York, NY, USA: The New York School of Regional Anesthesia; 2004.
[2] Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006; 104(2):368-73
[3] Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015; 9:148-54.
[4] Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010; 111:1548-51.
[5] Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (a2 agonist drugs) as an adjuvant to local Anesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study. Indian J Anaesth. 2012; 56:243-9.
[6] Zhang Y, Wang CS, Shi JH, Sun B, Liu SJ, Li P, et al. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block. Int J Clin Exp Med. 2014; 7:680-5.
[7] Feng Y, Chang P, Chen XB, Yang XL, Zhang YJ, Zhang WS. Intravenous versus perineural dexmededetomidine in prolongation of analgesia with regional anesthesia: A meta-analysis and systemic review. Pain Medicine. 2021; 6(2)
[8] Hussain N, Brummett CM, Brull R, Alghothani Y, Moran K, Sawyer T, et al. Efficacy of perineural versus intravenous dexmedetomidine as a peripheral nerve block adjunct: a systematic review. Reg Anesth Pain Med. 2021; 46(8):704-712.
[9] Sivakumar RK, Panneerselvam S, Cherian A, Rudingwa P, Menon J. Perineural vs. intravenous dexmedetomidine as an adjunct to bupivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries: A randomised control trial. Indian J Anaesth. 2018; 62:851-7.
[10] Reddy BS, Gaude YK, Vaidya S, Kini GK, Budania LS, Eeshwar MV. Effect of dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block with levobupivacaine-A prospective double-blind randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2021; 37:371-7.
[11] Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2017; 118 (2): 167–81.
[12] Gill M, Green SM, Krauss B. A study of the bispectral index monitor during procedural sedation and analgesia in the emergency department. Ann Emerg Med, 2003; 41: 234-41.
[13] 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 hyperpolarization-activated cation current. Anesthesiology. 2011; 115:836-43.
[14] Andersen JH, Grevstad U, Siegel H, Dahl JB, Aex MB, Mathiesen O, Jæger P. Does Dexmedetomidine Have a Perineural Mechanism of Action When Used as an Adjuvant to Ropivacaine? A Paired, Blinded, Randomized Trial in Healthy Volunteers. Anesthesiology. 2017; 126:66-73.
[15] Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, et al. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: A randomized, three-arm, triple-masked, placebo-controlled trial. Anesthesiology. 2016; 124:683-95.
[16] Afsani N. clinical application of dexmedetomidine. S Afr J Anaesthesiol Analg. 2010; 16: 50-56.
[17] Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992; 77:1134-42.
[18] Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H, Viinamaki O, et al. Effects of dexmedetomidine, a selective alpha 2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989; 46:33-42.
[19] Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg. 2000; 90(3): 699-705.
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IssueVol 10 No 1 (2024): Winter QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v10i1.14767
Keywords
Dexmedetomidine Adjuvant Supraclavicular brachial plexus block Ropivacaine Perineural
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How to Cite
1.
Sharmal V, Yadav P, Tak M. The Block Facilitatory Effects of Perineural Dexmedetomidine in Supraclavicular Brachial Plexus Block with Ropivacaine: Does Dexmedetomidine Has Perineural Site of Action? A Randomized, Controlled and Triple Blind Study. Arch Anesth & Crit Care. 2023;10(1):15-23.