A Comparative Study of Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG Guided Axillary Block for Elbow, Forearm and Hand Surgeries

Abstract

BACKGROUND AND OBJECTIVES: The present clinical study was conducted to evaluate the onset of analgesia, degree of sensory and motor blockade, duration of analgesia and complications between Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG guided axillary brachial plexus block. METHODS: The study was conducted on 60 ASA 1 and 11 patients of either sex posted for various elective or emergency surgeries of the upper limb involving elbow, forearm and hand surgeries. The subjects were divided into two groups, group A receiving axillary brachial plexus block with 0.25% Levobupivacaine alone and group B receiving Levobupivacaine with Dexmeditomidine 0.5μg /kg. Patients’ vital parameters were monitored throughout the procedure and in the post-operative period for 48 hours. A thorough observation was made on onset, quality, duration of analgesia, degree of motor blockade and complications. RESULT: The onset of sensory blockade (mean difference 0.04 minutes, p-value <0.001) and motor blockade (mean difference 0.03 minutes, p-value <0.001) were quicker in group B compared to group A. Both these findings were statistically significant. Both the duration of sensory blockade (mean difference 4.7 hours, p value <0.001), and motor blockade (mean difference 1.8 hours, p value <0.001) were longer in group B compared to group A and both these findings were statistically significant. Time taken for starting of regression (mean difference -1.37 minutes, p-value <0.108) was more in group B compared to Group A, but this finding was not statistically different. All other parameters related to duration of anesthesia including time taken for full motor and sensory recovery were longer in Group B compared to Group A. These differences were statistically significant. There were statistically significant differences in the duration of complete analgesia, duration of effective analgesia and time of first pain medication between the study groups. All these parameters were longer in Group B compared to Group A. The average post anesthesia hemodynamic parameters like heart rate, systolic and diastolic pressures were higher in Group A compared to Group B. The difference in the heart rate and diastolic blood pressure were statistically significant. The post anaesthetic respiratory parameters were almost similar in both the study groups. INTERPRETATION AND CONCLUSION: In this prospective randomized double blinded case control study, Levobupivacaine with Dexmeditomidine seems to be advantageous over plain levobupivacaine in terms of onset, quality and intensity of sensory and motor blockade. The duration of analgesia is both clinically and statistically significantly prolonged in Levobupivacaine with Dexmeditomidine group.