Comparative Evaluation between Ropivacaine versus Ropivacaine with Dexmedetomidine in Ultrasound Guided Parasagittal Brachial Plexus Approach in Upper Limb Orthopedic Surgeries

Abstract

Background: Ropivacaine has been used for brachial plexus block because of its safety profile. Dexmedetomidine is one of the adjuvants added to Ropivacaine as it is known to potentiate sensory and motor blockade. Aim: Our aim was to compare and assess the effectiveness of adding Dexmedetomidine as an adjuvant to 0.75% ropivacaine in supraclavicular brachial plexus block using parasagittal approach for duration of analgesia primarily. Onset and duration of sensory and motor blockade were also the variables compared. Materials and methods: A prospective single blinded randomized comparative clinical study was carried out among in eighty patients of ASA Grade I and II between the ages of 20-60yrs, scheduled for elective upper limb orthopedic surgeries involving the forearm under supraclavicular brachial plexus block using parasagittal approach. Group R received 20ml of 0.75% ropivacaine along with 1ml of normal saline while Group RD received 20ml of 0.75% ropivacaine along with 0.5mcg/kg dexmedetomidine constituted to 1ml. Sensory, motor blockade & analgesic efficacy was determined. Statistical Analysis: Student t-test was used for demographic and hemodynamic data analysis. Unpaired t-test was used for evaluation of data which consisted of onset, duration of sensory and motor blockade along with duration of analgesia. The results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant. Results: Duration of analgesia lasted longer in Group RD (991.09 ± 16.34) when compared to Group R (542.57 ± 18.37). Onset time for sensory and motor blockade were rapid in Group RD (7.71 ± 1.23, 13.66± 1.03) when compared to Group R (10.14 ± 1.00, 18.60 ± 1.54). Duration of sensory blockade was prolonged in Group RD (780.26 ± 31.43) when compared to Group R (455.57± 20.28). Duration of motor blockade was also enhanced in Group RD (725.57 ± 25.18) when compared to Group R (397.74 ± 24.92). Conclusion: Addition of Dexmedetomidine to Ropivacaine provided superior analgesia along with faster onset and longer duration of sensory and motor blockade.