Ropivacaine In Brachial Plexus Block Research Articles

A comparative study of efficacy of ropivacaine (0.75%) with adjuvants – dexmedetomidine and fentanyl in supraclavicular brachial plexus block

Background: Brachial plexus block is preferred to general anesthesia (GA) as it reduces many complications of GA, provides good intra and postoperative analgesia, adequate muscle relaxation. Addition of adjuvants along with LA is used to prolong block with improved quality of anesthesia and decrease dose of LA. This study was done to see the efficacy of Ropivacaine with dexmedetomidine and fentanyl in terms of duration of action and pain relief. Aims and Objectives: Dexmedetomidine and Fentanyl along with Ropivacaine in patients undergoing upper limb surgeries, the onset and duration of sensory and motor blockade as well as post op analgesia is compared. Materials and Methods: Prospective Randomized Comparative study with three groups randomly divided received total volume of 30 mL of drug in peripheral nerve stimulator guided supraclavicular blocks in patients undergoing upper limb surgeries. Group Dexmedetomidine received 28 cc of 0.75% Ropivacaine and Dexmedetomidine (1 mcg/kg), Group Fentanyl patients received 28 cc of 0.75% Ropivacaine and fentanyl (1 mcg/kg), whereas, group plain Ropivacaine patients received 28 cc of 0.75% Ropivacaine and 2 mL of normal saline. Haemodynamics, sensory and motor block (MB) were evaluated by VAS and modified Bromage scale. Results: The onset of sensory block and MB in the dexmedetomidine group, fentanyl group, and ropivacaine groups was 3.57±0.50 min and 4.47±0.51 min, 5.50±0.51 min and 7.53±0.51 min, and 8.07±0.79 min and 10.07±0.79 min respectively which were statistically significant. The duration of MB in the dexmedetomidine group, fentanyl group, and ropivacaine group were 6.57±0.50 h, 4.47±0.51 h, and 2.50±0.51 h respectively which was statistically significant (P=0.0000). The duration at which first postoperative analgesia was required in the dexmedetomidine group, fentanyl group, and ropivacaine group were 8.57±0.50 h, 6.57±0.50 h, and 5.30±0.47 h respectively. Conclusion: Dexmedetomidine is better as an adjuvant to Ropivacaine for brachial plexus block in terms of onset and duration.

A Comparative Study of Ropivacaine and Ropivacaine with Dexmedetomidine during Interscalene Brachial Plexus Block in Upper Arm Surgeries

Pain is a complex multidimensional human perception. It is divine to allay pain, Says Galen. In treatise on gout and rheumatism English physician Thomas Sydenham in 17th century wrote-“Among the remedies, which it has pleased Almighty God to give man to relieve his suffering none is so universal and as efficacious as opium.” Specifically, we tested the hypothesis that adding dexmedetomidine significantly prolongs the duration of analgesia. Another objective of the study was to assess the extent to which the duration of analgesia and Anaesthesia is prolonged with the addition of Dexmedetomidine. Ropivacaine 0.50% used in brachial plexus block is well tolerated and provides effective surgical Anaesthesia as well as relief of postoperative pain. Dexmedetomidine as an adjuvant to ropivacaine enhances the quality of ISB block by faster onset of sensory and motor block. Dexmedetomidie increases the duration of both sensory and motor blockade. Duration of analgesia was significantly increased by dexmedetomidine when added to ropivacaine in brachial plexus block. Though statistically insignificant, addition of dexmedetomidine results in more intraoperative hemodynamic stability. Both dexmedetomidine and ropivacaine do not cause any major side effects in anaesthesia techniques. Thus, this study shows that dexmedetomidine 150 μg added to ropivacaine 0.50% in an appropriate technique has low side effect profile with considerable therapeutic benefit and enhances the quality of ISB block.

Comparison of morphine, dexmedetomidine and dexamethasone as an adjuvant to ropivacaine in ultrasound-guided supraclavicular brachial plexus block for postoperative analgesia-a randomized controlled trial.

Background and Aims:An ideal adjuvant to local anesthetic in a nerve block should prolong the duration of analgesia, and hasten the onset of sensory and motor blockade without significant adverse effects. The aim of this study was to compare morphine, dexmedetomidine, and dexamethasone as an additive to ropivacaine in ultrasound-guided supraclavicular brachial plexus block (SBPB) for postoperative analgesia.Material and Methods:In this randomized, double-blinded study, 150 patients undergoing upper extremity surgery were randomly divided into three groups: group A (morphine 5 mg), group B (dexmedetomidine 50 μg), and group C (dexamethasone 8 mg). The additives were added to 30 ml of 0.5% ropivacaine solution and administered in SBPB. The duration of postoperative analgesia, onset of sensory and motor blockade, sedation, and adverse effects were observed. The pain was assessed by visual analog scale (VAS) and sedation by Ramsay sedation score. The duration of postoperative analgesia was taken as time consumed from block completion to administration of rescue analgesia (VAS >3).Results:The demographic profile was similar in both groups. The duration of analgesia was significantly longer in dexamethasone (867.2 ± 217.6 min) than morphine (739. 2 ± 162.5 min) and dexmedetomidine (654.2 ± 179.9 min) (P < 0.001). The onset of sensory and motor blockade was quicker with dexmedetomidine than dexamethasone and morphine. Three cases of block failure were reported with morphine. No major adverse effects were reported.Conclusion:Dexamethasone is an ideal adjuvant to ropivacaine in brachial plexus block to prolong postoperative analgesia and devoid of adverse effects. Dexmedetomidine has a quicker onset of sensory and motor blockade.

To Compare Isobaric 0.5% Levobupivacaine With Isobaric 0.5% Ropivacaine In Brachial Plexus Block For Elective Upper Limb Surgery

Background: The purpose of the investigation is to Compare Isobaric 0.5% Levobupivacaine With Isobaric 0.5% Ropivacaine In Brachial Plexus Block For Elective Upper Limb Surgery. Subjects and Methods: Intravenous access was obtained in the limb opposite to that undergoing surgery with an intravenous cannula-18G. Standard monitors, ECG, pulse oximeter, non invasive blood pressure, respiratory monitoring were connected and monitored continuously in all the patients and recorded at interval of 0, 5, 10, 15, 20, 30, 60 minutes in the first hour and every 30 minutes thereafter till the end of surgery. All emergency equipments including intubation aids and drugs such as midazolam, thiopentone or propofol and 20% of lipid emulsion were kept ready to deal with any adverse events during the course of procedure/ surgery. Sixty patients aged between 18yrs and 60yrs physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries were included in the study. Results: Demographic details Age, sex and weight were comparable in both the groups (no significant statistical difference was observed). These eliminated possible bias in term of gender, age, and weight distribution which can alter the study drugs pharmacokinetics and dynamics. The average pulse rate, mean arterial pressure, oxygen saturation and respiratory rate readings at frequent intervals did not differ significantly between two intervention groups ( p&gt; 0.05 for all) No clinically significant bradycardia or hypotension was noted. Conclusion: Levobupivacaine should be considered for peripheral nerve block when postoperative analgesia is a concern but not when an early return of motor function is desired in postoperative period for upper limb elective surgeries. Demographic details Age, sex and weight were comparable in both the groups (no significant statistical difference was observed). These eliminated possible bias in terms of gender, age, and weight distribution which can alter the study drug pharmacokinetics and dynamics. The average pulse rate, mean arterial pressure, oxygen saturation and respiratory rate readings at frequent intervals did not differ significantly between two intervention groups ( p&gt; 0.05 for all) No clinically significant bradycardia or hypotension was noted.

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvant to Ropivacaine in Brachial Plexus Block

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvant to Ropivacaine in Brachial Plexus Block

To Compare Isobaric 0.5% Levobupivacaine with Isobaric 0.5% Ropivacaine in Brachial Plexus Block For Elective Upper Limb Surgery.

To Compare Isobaric 0.5% Levobupivacaine with Isobaric 0.5% Ropivacaine in Brachial Plexus Block For Elective Upper Limb Surgery.

Adding Clonidine to Ropivacaine in Brachial Plexus Block for Upper Limb Surgeries: Study of Hemodynamic Variables

Background: Ropivacaine is a long acting amide local anaesthetic agent. It was first synthesized in 1957 along with bupivacaine and mepivacaine. It is a pure S-enantiomer while bupivacaine is a racemic mixture. Ropivacaine causes reversible inhibition of sodium ion influx, and thereby blocks impulse conduction in nerve fibres. This action is potentiated by dose-dependent inhibition of potassium channels. Subjects and Methods: This study was conducted on 60 patients undergoing upper limb surgeries aged between 18 to 55 years under supraclavicular block. Informed written consent was taken. Result values were recorded using a preset proforma. Results: There were 24 patients in Group R and 23 patients in Group RC belonging to ASA Grade I, and 6 patients in Group R and 7 patients in Group RC belonging to ASA Grade II which was considered statistically not significant. Conclusion: The combination produces improved analgesia, resulting in a prolonged effect and stable hemodynamics.

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials.

Background:Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB).Methods:A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers.Results:Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], −3.86 minutes, 95% CI −5.45 to −2.27 minutes; I2 = 85%) and motor (MD, −5.21 minutes; 95% CI −7.48 to −2.94 minutes; I2 = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87–269.52 minutes; I2 = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48–230.91 minutes; I2 = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes; I2 = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI −0.02 to 0.05, I2 = 45%; P = .45) and hypotension (RD, 0.01, 95% CI −0.01 to 0.03, I2 = 0%; P = .57) between 2 groups.Conclusion:Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.

Clonidine as an Adjuvant to Ropivacaine in Brachial Plexus Block

Clonidine as an Adjuvant to Ropivacaine in Brachial Plexus Block

A Clinical Comparison between 0.5% Bupivacaine and 0.75% Ropivacaine in Brachial Plexus Block Through Axillary Approach

A Clinical Comparison between 0.5% Bupivacaine and 0.75% Ropivacaine in Brachial Plexus Block Through Axillary Approach

To Evaluate the Efficacy of Fentanyl and Dexmedetomidine as Adjuvant to Ropivacaine in Brachial Plexus Block: A Double-blind, Prospective, Randomized Study.

Context:Anesthesia and analgesia for surgeries to the upper extremity are commonly provided using brachial plexus anesthesia. There are limited or almost no studies comparing the use of ropivacaine with fentanyl to ropivacaine with dexmedetomidine.Aims:To compare the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine for brachial plexus block among patients undergoing upper limb orthopedic surgeries.Settings and Design:This was a prospective, randomized, double-blinded study.Subjects and Methods:The patients were randomly divided into three groups of 35 each using computerized randomization table. Group I patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of fentanyl diluted with normal saline (NS) to make a total volume of 35 ml. Group II patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of dexmedetomidine diluted with NS to make a total volume of 35 ml. Group III patients received 3 mg/kg of 0.75% ropivacaine with NS making a total volume of 35 ml.Statistical Analysis Used:Statistical analysis was performed using Statistical Package for Social Sciences, version 15.0. Analysis of variance followed by independent samples t-test was performed for parametric data, and Kruskal–Wallis test followed by Mann–Whitney U-test was performed for nonparametric data.Results:Mean motor and sensory block onset time was minimum in Group I and maximum in Group III while mean duration of sensory and motor block was maximum in Group I and minimum in Group III. Time taken for first rescue analgesic dose was also maximum in Group I and minimum in Group III.Conclusions:It can be concluded that 3 mg/kg of 0.75% ropivacaine along with 1 μg/kg of fentanyl diluted with NS to make a total volume of 35 ml was the most efficacious regimen for brachial plexus block among patients undergoing upper limb orthopedic surgeries.

A comparative study of 0.5% ropivacaine and 0.5% levobupivacaine in supraclavicular brachial plexus block

Background: To compare the clinical profiles of levobupivacaine and ropivacaine at equipotent doses for supraclavicular brachial plexus block for upper limb surgeries, we hypothesized that both will induce a similar upper limb anesthetic blockade in terms of sensory and motor blockades. Objective: To evaluate the effects of levobupivacaine and compare it with ropivacaine in brachial plexus block through supraclavicular route. Materials and Methods: For this prospective study, 60 patients of both sexes ASA I/II were enrolled and divided into two groups, and supraclavicular brachial plexus block was performed using levobupivacaine 0.5% and ropivacaine 0.5% using classical approach. The onset of sensory and motor block, their duration, and possible adverse events were recorded. Result: No statistically significant difference was observed in the onset of sensory block in both the groups. Onset of motor blockade was significantly faster with ropivacaine (9.50 ± 2.403 min) as compared to levobupivacaine (12.33 ± 2.537 min; P < 0.05). Duration of sensory and motor block was significantly short for ropivacaine than levobupivacaine (P < 0.05). Levobupivacaine has significantly longer duration of analgesia (12.56 ± 1.30 h) as compared to ropivacaine (9.93 ± 1.7 h; P < 0.05). Conclusion: Levobupivacaine, a novel long-acting local anesthetic agent, having better profile in terms of duration of analgesia, with a considered disadvantage of delayed wearing off of motor blockade, offers an alternative to ropivacaine for brachial plexus block in upper limb surgeries.

Effects of different doses of dexmedetomidine on median effective concentration of ropivacaine for brachial plexus block

Objective To determine the optimum dose of dexmedetomidine administered locally through evaluating the effects of different doses of dexmedetomidine on the median effective concentration(EC50)of ropivacaine for brachial plexus block. Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 19-50 yr, weighing 50-80 kg, scheduled for elective ulna and radius fracture open reduction and internal fixation, requiring ultrasound-guided axillary brachial plexus block, were randomly assigned into 4 groups using a random number table: control group(group C)and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg groups(D1, D2 and D3 groups). Axillary brachial plexus block was performed only with ropivacaine in group C. In D1-3 groups, axillary brachial plexus block was performed with the mixture of ropivacaine and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg, respectively.The effective block was defined as complete loss of pain sensation in the areas innervated by the brachial plexus.The volume of local anesthetics was 40 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.4% and the ratio between the two successive concentrations was 1.0.If the block was effective, the next patient received a lower dose of ropivacaine; or conversely if ineffective, a higher dose was given in the next patient.At least 7 independent crossover pairs were observed in each group.The EC50 of ropivacaine was the mean of the concentration of ropivacaine of each crossover pair.The occurrence of brachial plexus block-related adverse events, adverse cardiovascular events and over-sedation was recorded. Results In C, D1, D2 and D3 groups, 20, 22, 24 and 19 patients were enrolled, respectively.Compared with group C, the EC50 of ropivacaine was significantly decreased in D2 and D3 groups, and no significant change in the EC50 of ropivacaine was found in group D1.No patients developed adverse events in group D1.The incidence of bradycardia was 17%, but it was transient in group D2.In group D3, the incidence of bradycardia and hypotension was 58% and 32%, respectively, and they required special treatment, and the incidence of over-sedation was 10%. Conclusion The optimum dose of dexmedetomidine is 0.6 μg/kg when mixed with ropivacaine for brachial plexus block. Key words: Dexmedetomidine; Amides; Brachial plexus; Nerve block; Dose-response relation, drug

Comparative study of 0.375% bupivacaine and 0.375% ropivacaine in brachial plexus block via supraclavicular approach

Objectives: To compare the effect of 35 ml of 0.375% bupivacaine and 35 ml of 0.375% ropivacaine in supraclavicular brachial plexus block. Materials and Methods: In this prospective double blind study, sixty patients of ASA- I and II scheduled for upper limb orthopedic surgeries were randomly divided into Group B and Group R which received 35 ml of 0.375% bupivacaine and 0.375% ropivacaine respectively. Sensory and motor block onset& duration and duration of analgesia were evaluated statistically using unpaired t-test and p-value < 0.05 was considered significant. Results: The sensory and motor onset (mean-minutes) was 21.13 and 25.87 in group Band was 13.3 and 21.37 in group R respectively. The duration of sensory and motor block (mean- minutes) was 480.3 and 472.8 in group R, and 472.1 and460.2 in group B The duration of post-operative analgesia was 504.2 minutes in Group R and 499.6 minutes in Group B. Conclusion: Group R provided statistically significant & rapid onset of sensory and motor blockade than Group B for upper limb surgeries. There were no significant differences in duration of sensory and motor blockade, any complication or side effects. Ropivacaine may be a preferred option because of its higher therapeutic index.

The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block.

BackgroundThe aim of this study was to evaluate the sedative effect of dexmedetomidine (DEX) added to ropivacaine for supraclavicular brachial plexus block (BPB) using the bispectral index (BIS).MethodsSixty patients (American Society of Anesthesiologists physical status 1 or 2, aged 20-65 years) undergoing wrist and hand surgery under supraclavicular BPB were randomly allocated to two groups. Ultrasound-guided supraclavicular BPB was performed with 40 ml of ropivacaine 0.5% and 1 µg/kg of DEX (Group RD) or 0.01 ml/kg of normal saline (Group R). The primary endpoint was the BIS change during 60 min after block. The secondary endpoint was the change in the mean arterial blood pressure (MAP), heart rate (HR), and SpO2 and the onset time and duration of the sensory and motor block.ResultsIn Group RD, the BIS decreased significantly until 30 min after the block (69.2 ± 13.7), but remained relatively constant to 60 min (63.8 ± 15.3). The MAP, HR and BIS were significantly decreased compared with Group R. The onset time of the sensory and motor block were significantly faster in Group RD than in Group R. The duration of the sensory and motor block were significantly increased in Group RD.ConclusionsDEX added to ropivacaine for brachial plexus block induced sedation that corresponds to a BIS value of 60 from which patients are easily awakened in a lucid state. In addition, perineural DEX shortened the onset time and prolonged the duration of the sensory and motor blocks.

Comparative Study of Clonidine and Dexmedetomidine as an Adjuvant with Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background: Among alpha 2 adrenergic agonists the role of Clonidine as an adjuvant to local anaesthetics to prolong duration of block is extensively studied but effect of Dexmedetomidine as an adjuvant to local anaesthetics in brachial plexus block is not much investigated. Aim: To compare effects of Clonidine and Dexmedetomidine with inj. Ropivacaine 0.5% in brachial plexus block with regard to block characteristics, post operative analgesia, hemodynamic stability and complications. Materials and Methods: 50 patients of ASA gr I and II undergoing upper extremity surgeries were selected and randomized to receive Clonidine(group RC) or Dexmedetomidine(group RD) with inj. Ropivacaine 0.5% 30 ml in supraclavicular brachial plexus block .Onset and duration of sensory and motor blockade, duration of post operative analgesia, hemodynamic parameters and adverse effects were compared. Results: Significant difference was observed in relation to duration of sensory block 346.8(±74.54) minutes in group RC and 540 (±56.12) min in group RD, duration of motor block 386.4(±67.82) min. and 586.8 (±55.51) min. respectively. Duration of post operative analgesia 372(±70.86) min in group RC and 559 (±55.40) min in group RD. No significant difference was observed in onset of sensory block which is 11.92(±2.55) min in group RC and 11.36(±2.14) min in group RD and onset of motor block which is 18.56(±2.12) min in group RC and 17.28(±2.70) min in group RD. Conclusion: The duration of sensory motor blockade and post operative analgesia was significantly prolonged by Dexmedetomidine with inj Ropivacaine in brachial plexus block without significant hemodynamic alterations. Key words: brachial plexus block, adjuvant, alpha-2 agonists, Clonidine, Dexmedetomidine

A comparative study between ropivacaine 30 ml (0.75%) and ropivacaine 30 ml (0.75%) with clonidine 150 μg as an adjuvant in brachial plexus block through supraclavicular approach

Background: Ropivacaine is a novel alternative to bupivacaine with the less cardiovascular system and central nervous system toxicity. Clonidine, an alpha 2 agonist, may have benefited patients when it is injected at peripheral nerve sites with local anesthetic ropivacaine. Clonidine is second only to epinephrine as a useful adjuvant for brachial plexus blockade. Objective: A clinical study was carried out to compare the anesthetic effects of ropivacaine alone and clonidine as an adjuvant to ropivacaine in brachial plexus block for upper limb surgeries. Materials and Methods: A comparative, double-blind, prospective, randomized, clinical study was carried out on 60 patients of either sex of American Society of Anesthesiologist physical status I and II, with age group 25-65 years undergoing various orthopedic surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly allocated to either of the two groups of 30 each. Group-R: Injection ropivacaine 30 ml (0.75%) with 1 ml normal saline. Group-ropivacaine clonidine (RC): Iinjection ropivacaine 30 ml (0.75%) with injection clonidine 1 ml (150 μg). Heart rate, mean arterial pressure, onset and duration of motor and sensory blockade were observed during preoperative, intraoperative and postoperative period. At the end of the study, the data were analyzed using Chi-square test for qualitative data and Student t-test. P < 0.05 was considered significant and P < 0.01 was considered as highly significant. Results: Demographic and hemodynamic data were comparable. Onset of sensory and motor block was significantly earlier in Group-R. Duration of analgesia and motor blockade was prolonged in the RC group. Both groups were observed for the side-effects, which were not significant. Conclusions: Addition of clonidine 150 μm to ropivacaine 0.75% 30 ml delays the onset of sensory and motor blockade while prolongs the postoperative motor blockade and analgesia significantly without producing any clinical significant side-effects in brachial plexus block through supraclavicular approach.

Effectiveness of 0.75% Ropivacaine for Brachial Plexus Block in Upper Limb Orthopaedic Surgery in Comparison with 0.5% Bupivacaine

Effectiveness of 0.75% Ropivacaine for Brachial Plexus Block in Upper Limb Orthopaedic Surgery in Comparison with 0.5% Bupivacaine

Association of clonidine and ropivacaine in brachial plexus block for shoulder arthroscopy

Background and objectivesArthroscopy for shoulder disorders is associated with severe and difficult to control pain, postoperatively. The addition of clonidine to local anesthetics for peripheral nerve block has become increasingly common, thanks to the potential ability of this drug to reduce the mass of local anesthetic required and to prolonging analgesia postoperatively. The present study aimed to evaluate the success of brachial plexus block for arthroscopic rotator cuff surgery using local anesthetic with or without clonidine. Method53 patients of both genders, between 18 and 70 years old, American Society of Anesthesiologists I or II, who were scheduled to undergo arthroscopic shoulder surgery were selected. Patients were then randomized into two groups. The verbal numerical pain scale and the presence of motor block were obtained in the post-anesthetic recovery room and 6, 12, 18 and 24h postoperatively. ResultsThe association of clonidine (0.15mg) to a solution of 0.33% ropivacaine (30mL) in brachial plexus block for shoulder arthroscopy has not diminished the visual numeric pain scale values, nor the need for opioid rescue postoperatively. There was a lower incidence of nausea/vomiting postoperatively and a significant motor block time prolongation in the group of patients who received clonidine as adjuvant. ConclusionsThe use of brachial plexus block with local anesthetic for analgesic postoperative control is well established in the literature. The addition of clonidine in the dose proposed for prolongation of the analgesic effect and reduction of opioid rescue proved unhelpful.

Addition of clonidine or lignocaine to ropivacaine for supraclavicular brachial plexus block: a comparative study

Clonidine is used with local anaesthetics to improve analgesia. However, the improvement conferred when clonidine is used together with ropivacaine is controversial. Thus, the present study aimed to evaluate the improvement in analgesia when clonidine is used together with ropivacaine for supraclavicular brachial plexus block. This was a prospective, randomised, double-blind controlled study. A total of 75 patients who were scheduled to undergo supraclavicular block were randomly assigned into three groups (i.e. clonidine, lignocaine and control groups) of 25. Patients in all three groups received 20 mL of 0.75% ropivacaine. In addition to that, patients in the clonidine group received 1 mL of clonidine (150 μg) plus 9 mL of saline, patients in the lignocaine group received 10 mL of 2% lignocaine with adrenaline (1:200,000), and patients in the control group received 10 mL of saline. The characteristics of anaesthesia and analgesia for these three groups were assessed. The addition of 2% lignocaine with adrenaline to ropivacaine led to earlier onset of the sensory block (by 4.88 mins), but no increase in the duration of analgesia when compared to analgesia using ropivacaine alone. The addition of clonidine to ropivacaine led to earlier onset of sensory and motor blocks (by 2.88 mins and 3.28 mins, respectively), as well as an increased duration of sensory and motor blocks (by 222.64 mins and 192.92 mins, respectively) when compared to analgesia using ropivacaine alone. The total duration of analgesia was increased by 208.24 mins with clonidine when compared to analgesia using ropivacaine alone. There were no significant differences in sedation score and no side effects in all three groups. When compared to the use of ropivacaine alone, the addition of 150 μg clonidine to ropivacaine for brachial plexus block achieved earlier analgesic onset and improved duration of analgesia, without unwanted side effects.