A Comparative Study between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract

Abstract Background Brachial plexus blocks are among the most commonly performed peripheral nerve blocks for upper extremity surgeries in clinical practice. It offers many advantages over general anaesthesia for upper limb surgeries such as sympathetic block, better postoperative analgesia, high success rate and fewer side effects. Objective To compare the efficacy of bupivacaine plus dexamethasone versus bupivacaine plus dexmedetomidine as adjuvants on the block characteristics including: onset and duration of sensory and motor blockade, duration of postoperative analgesia, the first analgesic request time, adverse effect and hemodynamic parameters of patients. Patients and Methods After obtaining approval from the medical ethical committee in El Demerdash Ain Shams University Hospital, this study was conducted in El Demerdash Ain Shams University Hospital. It included patients scheduled for elective upper limb orthopedic and plastic surgery. A written informed consent was obtained from every patient after explaining the procedure. Results Regarding demographic data and operative characteristics there were no statistically significant difference between the two groups. The current study showed that the addition of dexmedetomidine to bupivacaine for supraclavicular brachial plexus block leads to prolongation of motor and sensory block duration, prolongation of duration of analgesia and decrease in total 24 hrs analgesia in comparative to dexamethasone. Conclusion Regarding comparison between dexmedetomidine and dexamethasone as an additive to bupivacaine in ultrasound guided supraclavicular block, it could be concluded that the addition of dexmedetomidine to bupivacaine shortened the onset times of both sensory and motor blocks, significantly prolonged their durations and prolonged the analgesia of brachial plexus block with subsequent consumption of less amounts of postoperative analgesics. Also the use of ultrasound guided technique decreased the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.