Abstract
Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Patients and methods: This prospective, randomized, single-blind clinical study conducted on 60 patients underwent upper limb surgery done by ultrasound-guided supraclavicular brachial plexus block; these patients allocated into two equal groups: Group I (control) received 20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc (19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results: Demographic data and surgical characteristics were comparable in both groups. The onset times for sensory and motor blocks were significantly shorter in Group II than Group I (P < 0.001), while the duration of blocks was considerably longer (P < 0.001) in Group II. Except for the first recordings (at 0, 5, and 10 min), heart rate levels in Group II were significantly lower (P < 0.001). MBP levels in Group II at 15, 30, 45, 60, 90 and 120 min were significantly lower than in Group I (P < 0.001). The duration of analgesia (DOA) was significantly longer in Group II than Group I (P < 0.001). As regards to the visual Analouge score, there is a highly significant difference at 6 hours, 8 hours and 10 hours in Group II than Group I. Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia.
Highlights
Brachial plexus nerve block has many potential advantages, including optimal pain control, reduced use of opioids, and facilitation of early discharge after ambulatory procedures [1].Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection.Conventional approaches used today, are all techniques that rely on surface landmarks before needle insertion, and elicitation of paraesthesia or nerve stimulated muscle contraction after needle insertion
Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic
The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia
Summary
Brachial plexus nerve block has many potential advantages, including optimal pain control, reduced use of opioids, and facilitation of early discharge after ambulatory procedures [1].Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection.Conventional approaches used today, are all (blind) techniques that rely on surface landmarks before needle insertion, and elicitation of paraesthesia or nerve stimulated muscle contraction after needle insertion. Often multiple trial-and-error needle attempts are necessary resulting in procedure-related pain and complications [2]. This is risky, for the supraclavicular approach, because of the chance of pneumothorax. Ultrasound guidance for brachial plexus blocks can permit the accurate deposition of the local anesthetic solution under constant observation and improve success rates and decrease the incidence of complication [3]. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia
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