scholarly journals Comparative Study for Anaesthetic Quality with the Addition of Clonidine, Fentanyl or Dexmedetomidine to 0.5℅ Ropivacaine in Supraclavicular Brachial Plexus Block at a Tertiary Hospital

2021 ◽  
pp. 1-3
Author(s):  
Naveen P

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.

2016 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Naina P Dalvi ◽  
Harshali Salunkhay ◽  
Shubha N Mohite

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.


Author(s):  
Daisy Karan ◽  
Swastika Swaro ◽  
Swarna Banerjee

ABSTRACTObjectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to localanesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We comparedthe sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicularbrachial plexus block.Methods: A total of 50 American Society of Anesthesiologist’s Physical Status I and II patients scheduled for elective upper limb surgeries undersupraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 mlbupivacaine with fentanyl 50 µg and Group BD received 30 ml bupivacaine with dexmedetomidine 50 µg. The characteristics for anesthesia andanalgesia were assessed in both groups.Results: Duration of sensory and motor block was 363.4±38.36 minutes and 357±36.77 minutes, respectively, in Group BF while it was452.96±77.12 minutes and 441.52±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motorblock between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF(471.44±65.88 minutes vs. 366.48±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any groupexcept for Grade 3 sedation score which was more in Group BD.Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motorblock and also the duration of analgesia, more than when fentanyl was added to bupivacaine.Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.


2017 ◽  
Vol 4 (1) ◽  
pp. 198
Author(s):  
Bidyut Borah ◽  
Smita R. Engineer ◽  
Kiran B. Patel

Background: Ultrasonography is a newer tool for identification of nerves in the practice of regional anaesthesia. Visualization of target structures and spread of drugs under direct vision and thus avoiding complications like pneumothorax, accidental intravascular injections are potential benefit of ultrasonography technique. Aim of the study was to examine the usefulness of ultrasound guided brachial plexus block and compare it with paresthesia technique with the believe that ultrasound guidance can shorten the onset as well as increase the duration of blockade..Methods: Eighty patients of either sex, 18-60 years, posted for upper limb surgery were divided into 2 groups according to the technique used to give block, group US (ultrasound technique) and group PA (paresthesia technique).  Both the groups received 0.5 % bupivacaine 20 ml with 8 mg of dexamethasone.Results: There was notable difference between the patient groups with regard to initiation of motor blockade (10 min group US vs 11.1 min group PA, p <0.0156) and sensory blockade (5.16 min group US vs 6.96 min group PA, p <0.0001) also duration of motor blockade (1272.88 min in group US vs 899.25 min in group PA, p <0.0001) and sensory blockade (1343.88 min in group US vs 996.75 min in group PA, p<0.0001).Conclusions: Ultrasound guided supraclavicular brachial plexus blocks result in a higher success rate with respect to onset and duration of blockade with less incidence of complications compared to paresthesia technique.


2021 ◽  
Vol 10 (24) ◽  
pp. 1825-1829
Author(s):  
Amol Singam ◽  
Punith M. Sirige

BACKGROUND Regional anaesthesia has multiple advantages as compared to general anaesthesia for upper limb surgeries. Here in this study, we wanted to compare bupivacaine 0.5 %, commonly used anaesthetic with ropivacaine 0.75 % which has fewer side effects like cardiotoxicity for supraclavicular brachial plexus block. METHODS A study was performed on 60 ASA I & II patients aged between 18 and 75 years, undergoing upper limb elective surgeries under brachial plexus block using nerve locator. Beginning of sensory and motor block, general nature of block, and terms of sensory and motor blocks were assessed in the C5 to T1 dermatomes. RESULTS There was no statistically significant difference in the onset of sensory and motor blockade between ropivacaine 0.75 % and bupivacaine 0.5 %. Ropivacaine 0.75 % produced similar quality of motor and sensory blockade compared to 0.5 % bupivacaine. The time taken for maximum motor blockade with ropivacaine was comparable with that of bupivacaine 0.5 %. There was no statistically significant difference regarding the duration of analgesia with ropivacaine 0.75 % compared to bupivacaine 0.5 %. Duration of motor blockade with 0.75 % ropivacaine was comparable to that of 0.5 % bupivacaine. CONCLUSIONS Ropivacaine 0.75 % 0.4 ml / kg or 0.5 % bupivacaine 0.4 ml / kg for supraclavicular brachial plexus block produces satisfactory and comparable sensory and motor blockade. It is suggested that lower cardiovascular toxicity of ropivacaine with equal efficacy as bupivacaine in such circumstances may help in reducing the risks to the patient. KEY WORDS Bupivacaine 0.5 %, Ropivacaine 0.75 %, Brachial Plexus Block, Upper Limb Orthopaedic Surgeries


2021 ◽  
pp. 9-11
Author(s):  
Avishek Naha ◽  
Sagar Rai ◽  
Amrita Roy ◽  
Gautam Piplai

Many studies have been done on the adjuvants used along with local anaesthetics for Brachial Plexus block. The drug Levobupivacaine has wider margin of safety and has been used in our study along with Dexamethasone as adjuvant. Method: We performed a prospective, randomized, controlled, single blinded study on a total of 70 patients who were randomly allocated into two groups namely Group N (Normal Saline) and Group D (Dexamethasone). Both groups received 28 ml 0.5% Levobupivacaine. Group D received 2 ml (8 mg) Dexamethasone as adjuvant while Group N received 2 ml Normal Saline. Onset of Sensory blockade and motor blockade were measured, respectively, by time taken to loss of pin prick sensation and loss of muscle movement, after administration of drug. Duration of sensory block was measured by time till patient rst reported pain after sensory blockade. Result:The onset time of sensory block was 10.2 ± 1.67 minutes in Group D compared to 12.3 ± 1.88 minutes in Group N (p value <0.0001). The onset time of motor block in Group D was 14.4 ± 1.73 minutes and in Group N 16.3 ± 1.97 min (p value = 0.0002). The duration of sensory block was 944.1± 64.79 minutes in Group D versus 654.7 ± 71.61 min in Group N (p value < 0.0001). Conclusion: It was observed that Group D had signicantly faster onset of sensory and motor blockade while also experiencing longer duration of analgesia.


2019 ◽  
pp. 1-3
Author(s):  
Chandrasekhar Behera

BACKGROUND AND OBJECTIVE:Regional anesthesia of the extremities and of the trunk is a useful alternative to general anesthesia in many situations. Brachial plexus block has now evolved into valuable and safe alternative to general anesthesia for upper limb surgeries. MATERIALS AND METHODS:This randomized study on Sixty ASA I and II candidates, were randomly allocated to receive 1.5% lidocaine (29 ml) with adrenaline (1:200,000) and either 1 ml of normal saline (group A, n=30) or 1 ml of dexamethasone (4 mg) (group B,n=30).The duration of sensory and motor block,duration of analgesia and number of rescue analgesics in post-op 24 hours were analyzed. RESULTS:The duration of sensory and motor blockade and post op analgesia (in mins) (178.60 ±30.26 vs. 420.73±80.87and 150.70±32.32vs.306.93±70.24 and 396.13±109.42 vs 705.80±121.46) respectively,were significantly longer in the dexamethasone group (P=0.001). CONCLUSION:Addition of dexamethasone to lidocaine with adrenaline in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade,duration of analgesia and lessens no of rescue analgesia needed in 24 hrs.


Author(s):  
Kushal Jethani ◽  
Preeti Sahu ◽  
Seethal Ann

Background and Objectives: Alpha-2 agonists are used as adjuvant with local anaesthetic agents to prolong the duration of spinal, epidural and peripheral nerve blocks as well as to prolong the duration of post operative analgesia. We performed a study to compare clonidine(1ug/kg) and dexmedetomidine (1ug/kg) as an adjuvant to 0.5% bupivacaine in supraclavicular brachial plexus block. Methods: Eighty ASA I and II patients scheduled for elective upper limb orthopaedic surgeries under supraclavicular brachial plexus block were divided into two  groups(n=25 each) in a randomized, double-blinded fashion. Group C received clonidine 1 μg/kg and Group D received dexmedetomidine 1 μg/kg added to bupivacaine 0.5% (30 cc). Onset and recovery time of sensory and motor block, as well as duration of analgesia were studied in both the groups. Results: Duration of sensory block and motor block was 220.12 ±50.3 and 280.1± 20.12 min respectively in group C, while it was 410.34± 60.12 and 460.4 ± 50.56 min respectively in group D and hence both were significantly prolonged in group D.  No statistically significant difference was seen in onset of sensory and motor block between the two groups. The duration of analgesia i.e. time to requirement of rescue analgesia was 270.4± 56.7 mins and 452.7 ±64.23 mins in group C and D respectively and  this difference was statistically significant (P=0.001). Conclusion: Addition of dexmedetomidine to bupivacaine 0.5% in supraclavicular brachial plexus block prolonged the duration of sensory and motor block as well as the duration of analgesia when compared with clonidine. Keywords: Clonidine, dexmedetomidine, supraclavicular block


2021 ◽  
pp. 138-142
Author(s):  
Deba Gopal Pathak ◽  
Dipanjali Nath

BACKGROUND : Supraclavicular approach to brachial plexus block is a versatile and reliable regional anesthesia technique and a suitable alternative to general anesthesia for upper limb surgical procedures. Ropivacaine , a long acting local anesthetic, with less tendency for neurotoxicity and cardiotoxicity is a great local anesthetic for the procedure. Use of adjuvant Dexmedetomidine , a potent alpha 2 adrenoreceptor agonist improves the quality of anesthesia as well as intra-operative and post-operative analgesia while maintaining haemodynamic stability, arousable sedation and mild respiratory depression. MATERIALS AND METHODS: Eighty patients aged between 18 and 60 years with ASA grade I or II posted for elective upper limb surgeries were included in the study and were randomly divided into 2 groups with forty patients in each. Group A received 0.5% ropivacaine (31 mL) and Group B received 0.5% ropivacaine + dexmedetomidine 1microgram/kg (31mL). Both groups were compared for onset time and duration of sensory blockade, onset time and duration of motor blockade , total duration of analgesia and associated side effects. CONCLUSION : Dexmedetomidine as an adjuvant to ropivacaine in the supraclavicular brachial plexus block for upper limb surgeries , significantly shortens the onset time and prolongs the duration of sensory and motor blocks, with longer duration of post-operative analgesia , with associated significant sedation and a few manageable side effects like bradycardia and hypotension.


2016 ◽  
Vol 10 (1) ◽  
pp. 27-33
Author(s):  
Bhawana Rastogi ◽  
Ankush Arora ◽  
Kumkum Gupta ◽  
Manish Jain ◽  
Vijendra Pal Singh ◽  
...  

Background: The present study was designed to evaluate the hypothesis that midazolam as an adjuvant to levobupivacaine would safely enhance the duration of analgesia without any adverse effects when compared with levobupivacaine alone, in ultrasound-guided supraclavicular brachial plexus block. Primary end points were the duration of sensory and motor block and secondary end points were sedation score and any other complications. Patients and Method: Eighty consenting patients of both sexes, aged 18-60 years of ASA physical status I-II were randomized into two groups of 40 patients each. Patients in Group LS received 19 ml of 0.5% levobupivacaine with 1 ml normal saline and patients in Group LM received 19 ml of 0.5% levobupivacaine with 1ml midazolam (50µg/kg) for supraclavicular brachial plexus block using ultrasound guidance. Onset time and duration of sensory and motor blockade and VAS scores were assessed as primary end points. Hemodynamic changes, sedation or any other drug or technique related adverse effects were taken as secondary effects. Results: Onset of sensory and motor blockade was lower in patients of Group LM. The mean duration of sensory analgesia was significantly prolonged in patients of Group LM (537.6 ± 101.01 vs. 319.80 ± 87.09 mins). The mean duration of motor blockade was also significantly enhanced in patients of Group LM (405.0 ± 61.62 mins) compared to Group LS (274.8 ± 46.30 mins). VAS scores were higher in Group LS than group LM. Sedation scores were similar in both the groups. Conclusion: Midazolam with 0.5% levobupivacaine has effectively enhanced the duration of sensory and motor block without significant sedation and any other side effect.


2021 ◽  
Vol 8 (02) ◽  
pp. 97-102
Author(s):  
Pradeep Kumar Das ◽  
Raviteja Vallabha ◽  
Sri Harsha Merugu ◽  
Hemnath Babu Kotla

BACKGROUND To improve the time of regional anaesthesia many methods have been used. Epinephrine continues to be the most commonly used drug for this purpose. We wanted to compare the effects of alpha-adrenergic agonists clonidine and adrenaline as an adjuvant to ropivacaine in blocking brachial plexus by the supraclavicular approach in patients undergoing upper limb surgeries. METHODS It is a prospective randomised comparative study conducted for 18 months in 40 patients randomly divided into group RA and group RC, conducted on American Society of Anesthesiology (ASA) I and II patients undergoing upper limb surgeries under supraclavicular brachial plexus block. In group RA 30 mL of 0.5 % ropivacaine with 5 microgram / mL of epinephrine was given and in group RC 30 mL of 0.5 % ropivacaine with 1 microgram / Kg of clonidine was given. RESULTS On comparing effects of added alpha-adrenergic agonists clonidine and epinephrine to ropivacaine for supraclavicular brachial plexus block, it was found that there was no significant difference in the onset of the sensory blockade and motor blockade in the two groups. Duration of sensory blockade was significantly more in the clonidine with ropivacaine group when compared with the epinephrine and ropivacaine. There was no significant difference in haemodynamic responses between the two groups. CONCLUSIONS Supraclavicular approach brachial plexus block is effective in terms of cost and performance, and the margin of safety along with good postoperative analgesia. Hence, it can be concluded that the addition of 1 µg / Kg of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block provides a longer duration of analgesia as compared to 5 µg / mL of epinephrine added to 0.5 % ropivacaine. KEYWORDS Ropivacaine, Supraclavicular Brachial Plexus, Epinephrine


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