Fentanyl versus dexmedetomidine with bupivacaine in ultrasound-guided supraclavicular block in hemodialysis shunt surgeries

Abstract

Background Ultrasound-guided supraclavicular brachial plexus block provides perfect option for patients with end-stage renal disease undergoing arteriovenous fistula for hemodialysis. Purpose To evaluate and compare the effects of adding fentanyl to bupivacaine versus bupivacaine with dexmedetomidine in ultrasound-guided supraclavicular brachial plexus block for shunt surgeries in chronic renal failure regarding the efficacy of block and possible adverse effects. Patients and methods A total of 30 adult patients with end stage renal disease (ESRD) admitted for shunt surgery in the arm or forearm under ultrasound-guided supraclavicular brachial plexus block were randomly assigned into two equal groups (15 patients each) according to adjuncts added to bupivacaine, either fentanyl or dexmedetomidine. The demographic data of the patients were recorded, and block characteristics were categorized according to sensory block onset time and duration and motor block onset time and duration. The hemodynamics, duration of analgesia, time of first analgesic administration, total dose of analgesics used, visual analogue scale score, Ramsay sedation score, and complications were recorded and subjected to statistical analysis. Results Both dexmedetomidine and fentanyl provide rapid onset and prolonged duration of both sensory and motor block but more with dexmedetomidine, and the results were statically significant. There is also a statistically significant difference in the duration of analgesia and sedation score in the side of dexmedetomidine. Demographic data and duration of surgery were not statistically significant between the two groups. Conclusion Addition of dexmedetomidine to bupivacaine to supraclavicular brachial plexus block provides more favorable condition for surgery than fentanyl, more duration of analgesia, and better sedation, with less hemodynamic variability and low incidence of complications.