Comparative study between bupivacaine-dexmedetomidine combination and bupivacaine (plain) in brachial plexus block using nerve stimulator

Abstract

Introduction: Brachial plexus block has evolved into a valuable and safe alternative to general anaesthesia for the upper limb surgeries. It is a great tool in the anaesthetic armamentarium for relief of pain preoperatively, perioperatively and post operatively. It is possible and desirable for patient to remain ambulatory. Adjuvants with local anaesthetics in brachial plexus block are being used to achieve quick, dense and prolonged block. Dexmedetomidine added to local anesthetics prolongs the duration of block and postoperative analgesia in brachial plexus block. Methods and Methodology: It is a prospective, randomised, comparative study of 60 patients admitted in a tertiary hospital for upper limb surgery who were posted under regional anaesthesia during the period of October 2012 to December 2014. The patients taken in this study were allocated into two groups randomly. Group B (n=30) 20millilitres (ml) of 0.5%% bupivacaine +1ml saline and group D (n=30) 20ml of 0.5% bupivacaine +1microgram (mcg)/kilogram (kg) dexmedetomidine was given. Results: There were no clinical or statistically significant differences in the demographic profile of patients in either group. Onset of sensory block in radial, median and ulnar nerve distributions were significantly shorter in group B. Motor onset was also significantly shorter in group B. However rescue time was higher in group D. There were no adverse effects noted in both the groups. There was a significant percentage of GA conversion seen in case of group. B. Discussion: Onset of sensory block was faster in Group B than in Group D, onset of motor block was faster in Group B than in Group D, and the difference was statistically significant. There was significant increase in duration of analgesia in Group D (456.12±97.99 min) as compared with Group B (289.67±62.50 min). The difference was statistically significant No side-effects (nausea, vomiting, dry mouth) were reported during the first 24 h in the post-operative period in both the groups. From this study, we would like to suggest that dexmedetomidine can be safely used with local anaesthetic in peripheral nerve blocks; however, further trials to determine the exact dose and effect of neurotoxicity on the human nerve are required.