Abstract
Background: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5℅ ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of sensory and motor blockade, prolongs the duration of the sensory blockade as compared to fentanyl. Dexmedetomidine shortens the onset of sensory and motor blockade much more than clonidine.
Highlights
Supraclavicular Brachial plexus block described as the “spinal of arm”, provides a rapid onset, complete, predictable and dense anaesthesia for mid humerus, forearm and hand surgery
Brachial plexus block causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery
Dexmedetomidine, clonidine added to ropivacaine shortens the onset of sensory and motor blockade, prolongs the duration of the sensory blockade as compared to fentanyl
Summary
Supraclavicular Brachial plexus block described as the “spinal of arm”, provides a rapid onset, complete, predictable and dense anaesthesia for mid humerus, forearm and hand surgery. Dexmedetomidine, an α2-receptor agonist, with α2/α1 selectivity, reported to improve the onset and duration of analgesia when given as adjuvant to local anaesthetics [3]. Supraclavicular Brachial plexus block described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. We compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5c/o ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital
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