Research Article

Comparison Between Dexamethasone Versus Clonidine as Adjuvants to 0.75% Ropivacaine in Ultrasound Guided Brachial Plexus Block for Upper Limb Orthopedic Surgeries: A Randomized Prospective Clinical Study

Abstract

Background: Ropivacaine is an amino-amide local anesthetic, extensively used for peripheral nerve blocks, numerous adjuvants have been added to Ropivacaine to prolong the duration of analgesia. Aim: To compare the effectiveness of adding Dexamethasone to Ropivacaine versus adding Clonidine to Ropivacaine in ultrasound guided supraclavicular brachial plexus block in terms of analgesic duration, onset & duration of sensory and motor blockade.
Methods: A prospective randomized single blinded study carried out in 70 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective upper limb orthopedic surgeries. Patients were randomly allocated into two groups, Group RC - patients received 20ml of 0.75% ropivacaine along with 1mcg/kg of clonidine diluted to 2ml of normal saline, Group RD - patients received 20ml of 0.75% ropivacaine along with 8mg of dexamethasone (2ml). Statistical Analysis: Onset & duration of sensorimotor blockade, duration of analgesia was assessed by Unpaired t-test. If p-value <0.05, results were statistically significant & p-value <0.001 were highly significant.
Results: Duration of analgesia is superior and statistically significant in Group RD (1,172.57± 18.37 vs 931.09± 16.3). Onset time for sensory (3.14 ± 1.00 vs 9.71± 1.23) and motor (7.60 ± 1.54 vs 13.66± 1.03) block is rapid in Group RD. Duration of sensory (1,106.57± 20.28 vs 786.26± 31.43) and motor (997.74 ± 24.9 vs 674.57 ± 2.18) block is enhanced in Group RD
Conclusion: Dexamethasone as an adjuvant to ropivacaine provided superior post-operative analgesia, faster onset and longer duration of sensory and motor blockade.

[1] Perlas A, Lobo G, Lo N, Brull R, Chan VW, Karkhanis R. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med. 2009; 34(2):171-6.
[2] Bafna U, Yadav N, Khandelwal M, Mistry T, Chatterjee CS, Sharma R. Comparison of 0.5% ropivacaine alone and in combination with clonidine in supraclavicular brachial plexus block. Indian journal of pain. 2015; 29(1):41.
[3] Ali QE, Manjunatha L, Amir SH, Jamil S, Quadir A. Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study. Indian J Anaesth. 2014; 58(6):709.
[4] Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003; 97(5):1514-7.
[5] Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011; 55(2):104-10.
[6] Mamdouh LE, Ghada HA, Sherief ZI, Eldin AA, Tarek EA. Effect of addition of dexamethasone to low volumes of local anaesthetics for ultrasound-guided supraclavicular brachial plexus block. Menoufia Medical Journal. 2015; 28(4):928.
[7] Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesth Essays Res. 2014; 8(2):202-8.
[8] Gadani H, Thippeswamy H, Gupta S. A comparative study between ropivacaine 30 ml (0.75%) and ropivacaine 30 ml (0.75%) with clonidine 150 μg as an adjuvant in brachial plexus block through supraclavicular approach. Sudan Medical Monitor. 2015; 10(1):11.
[9] Marhofer P, Columb M, Hopkins PM, Greher M, Marhofer D, Bienzle M, et al. Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple- blinded crossover study in volunteers. Br J Anaesth. 2019; 122(4):525-31.
[10] Singelyn FJ. Clinical application of ropivacaine for the upper extremity. Curr Top Med Chem. 2001; 1(3):219-25.
[11] Dar FA, Jan N, Najar M. Effect of addition of dexamethasone to ropivacaine in supraclavicular brachial plexus block. Indian Journal of Pain. 2013; 27(3):165.
[12] Ali Q, Manjunatha L, Amir S, Jamil S, Quadir A. Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study. Indian Journal of Anaesthesia. 2014;58(6):709.
[13] Saied NN, Gupta RK, Saffour L, Helwani MA. Dexamethasone and clonidine, but not epinephrine, prolong duration of ropivacaine brachial plexus blocks, cross-sectional analysis in outpatient surgery. Pain Medicine. 2017;18(10):2013-26.
[14] Sakae TM, Marchioro P, Schuelter-Trevisol F, Trevisol DJ. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a randomized, double-blinded clinical trial. J Clin Anesth. 2017; 38:133-6.
[15] Albrecht E, Vorobeichik L, Jacot-Guillarmod A, Fournier N, Abdallah FW. Dexamethasone is superior to dexmedetomidine as a perineural adjunct for supraclavicular brachial plexus block: systematic review and indirect meta-analysis. Anesth Analg. 2019; 128(3):543-54.
Files
IssueVol 10 No 1 (2024): Winter QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v10i1.14773
Keywords
Brachial plexus block Ultrasound Ropivacaine Dexamethasone Clonidine
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Balakrishnaiah M, Sheshadri K, Ramegowda S, Srinivasan R, Ullas Lolakrishna R, T Sambandam M. Comparison Between Dexamethasone Versus Clonidine as Adjuvants to 0.75% Ropivacaine in Ultrasound Guided Brachial Plexus Block for Upper Limb Orthopedic Surgeries: A Randomized Prospective Clinical Study. Arch Anesth & Crit Care. 2023;10(1):55-59.