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

Sarita S Swami, Varshali M Keniya, Sushma D Ladi, Ruchika Rao, Sarita S Swami, Varshali M Keniya, Sushma D Ladi, Ruchika Rao

Abstract

Background and objectives: Alpha-2 agonists are mixed with local anaesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. We compared clonidine and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of analgesia.

Methods: Sixty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blinded fashion. Group C received clonidine 1 μg/kg and Group D received dexmedetomidine 1 μg/kg added to bupivacaine 0.25% (35 cc). Onset and recovery time of sensory and motor block, duration of analgesia and quality of block were studied in both the groups.

Results: Duration of sensory block and motor block was 227.00±48.36 and 292.67±59.13 min, respectively, in group C, while it was 413.97±87.13 and 472.24±90.06 min, respectively, in group D. There was no statistically significant difference in onset of sensory and motor block between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in group D was 456±97 min, while in group C, it was 289±62 min. Statistically, this difference was significant (P=0.001). The number of patients achieving grade IV quality (excellent) of block was higher in group D (80%) as compared with group C (40%) (P<0.05).

Conclusion: Dexmedetomidine when added to local anaesthetic in supraclavicular brachial plexus block enhanced the duration of sensory and motor block and also the duration of analgesia. The time for rescue analgesia was prolonged in patients receiving dexmedetomidine. It also enhanced the quality of block as compared with clonidine.

Keywords: Clonidine; dexmedetomidine; supraclavicular block.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Comparison of pulse rate in both the groups
Figure 2
Figure 2
Comparison of systolic blood pressure and diastolic blood pressure in both the groups
Figure 3
Figure 3
Comparison of duration of sensory block, motor block and analgesia in both the groups

References

    1. Damien B, Murhy, Collin JL, Cartney, Vincent WS. Novel analgesic adjuvants for brachial plexus block: A systemic review. Anesth Analg. 2000;90:1122–8.
    1. Elliott S, Eckersall S, Fliqelstone L. Does addition of clonidine affect duration of analgesia of Bupivacaine in inguinal hernia repair. Br J Anaesth. 1997;79:446–9.
    1. Singelyn FJ, Gouveineur J, Robert A. A minimum dose of clonidine added to mepivacaine prolongs duration analgesia after brachial plexus block. Anesth Analg. 1996;83:1046–50.
    1. Popping DM, Elia N, Marret E, Wenk M, Tramèr 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.
    1. Raimo V, Juha M, Veijo S, Leena N, Virtanen R. Characterisation of selectivity, specificity and potency of medetomidine as α2 adrenoceptor agonist. Eur J Pharmacol. 1988;150:9–14.
    1. Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55:352–7.
    1. 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.
    1. 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.
    1. 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.
    1. Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potential in frog sciatic nerve without α2 adrenoceptor activation. Br J Pharmacol. 2010;160:1662–76.
    1. Kanazi GE, Aouad MT, JAbbour- Khoury SL, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effects of low dose Dexmedetomidine or clonidine on characteristics of spinal block. Acta Anaesthesiol Scand. 2006;50:222–7.
    1. Memis D, Turan A, Karamanlioglu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lignocaine for IVRA. Anesth Analg. 2004;98:835–40.
    1. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anaesth Analg. 2010;111:1548–51.
    1. 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.
    1. Sarkar DJ, Khurana G, Chaudhary A, Sharma J P. A comparative study on the effects of adding fentanyl and buprenorphine to local anaesthetics in brachial plexus block. Journal of Clinical and Diagnostic Research. 2010;4(6):3337–43.
    1. Ramsay MA, Savage TM, Simpson BR, Godwin R. Controlled sedation with alphaxolone-alphadolone. Br Med J. 1974;2:656–9.
    1. Dalle C, Schneider M, Clergue F, Bretton C, Jirounek P. Inhibition of the I (h) current in isolated peripheral nerve: A novel mode of peripheral antinociception? Muscle Nerve. 2001;24:254–61.
    1. Abosedira MA. Adding clonidine or dexmedetomidine to lignocaine during Biers block: A comparative study. J Med Sci. 2008;8:660–4. Doi:10.3923/jms.2008.660-664.

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