|Year : 2021 | Volume
| Issue : 1 | Page : 154-157
Ropivacaine with dexmedetomidine versus ropivacaine alone in ultrasonography-guided supraclavicular brachial plexus block: A comparative study
LK Dash1, K Raghu2, G Rajaram1
1 Department of Anaesthesiology, 5 Air Force Hospital, Jorhat, Assam, India
2 Department of Anaesthesiology, 4 Air Force Hospital, West Midnapore (D), West Bengal, India
|Date of Submission||28-Jun-2020|
|Date of Decision||18-Nov-2020|
|Date of Acceptance||09-Dec-2020|
|Date of Web Publication||29-Jul-2021|
Dr. K Raghu
Department of Anesthesiology, 4 Air Force Hospital, Kalaikunda, West Midnapore (D), West Bengal
Source of Support: None, Conflict of Interest: None
Context: Supraclavicular brachial plexus block is the most flavored technique for upper limb surgeries in the day-to-day anesthetic practice. Adjuvants are commonly used along with local anesthetics to improve the overall quality of block. Dexmedetomidine is a α2 adrenoceptor agonist, nowadays gaining popularity due to its favorable outcomes. Aims: The aim of this study is to compare the block characteristics of 0.5% 30 ml ropivacaine alone with 0.5% 30 ml ropivacaine combined with 50 mcg of dexmedetomidine. Settings and Design: This was a prospective randomized controlled study. Materials and Methods: One hundred patients in the age group of 20–60 years, of American Society of Anesthesiologists Grade I and II, scheduled for elective upper limb surgeries were included in this study. Patients were divided into two groups of 50 each to receive either ropivacaine alone (Group A) or ropivacaine-dexmedetomidine combination (Group B). Onset and duration of sensory and motor blockade were assessed. Statistical Analysis Used: Standard qualitative and quantitative tests were used to compare data. P < 0.05 was considered statistically significant. Results: The onset of sensory and motor blockade was faster in Group B when compared to Group A (17.32 ± 2.05 min, 24.23 ± 5.83 min vs. 22.58 ± 1.75 min, 28.61 ± 2.78 min), the duration of sensory and motor blockade was longer in Group B when compared to Group A (635.0 ± 27.12 min, 513.21 ± 26.14 min vs. 501.1 ± 33.14 min, 402.17 ± 18.16 min), and the duration of analgesia was also longer in Group B compared to Group A (338.16 ± 10 min vs. 247.20 ± 12 min). Conclusion: Dexmedetomidine as an adjuvant to ropivacaine fastened the onset of block, prolonged the duration of block, and prolonged the duration of analgesia.
Keywords: Analgesia, brachial plexus block, dexmedetomidine, ropivacaine
|How to cite this article:|
Dash L K, Raghu K, Rajaram G. Ropivacaine with dexmedetomidine versus ropivacaine alone in ultrasonography-guided supraclavicular brachial plexus block: A comparative study. J Datta Meghe Inst Med Sci Univ 2021;16:154-7
|How to cite this URL:|
Dash L K, Raghu K, Rajaram G. Ropivacaine with dexmedetomidine versus ropivacaine alone in ultrasonography-guided supraclavicular brachial plexus block: A comparative study. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 23];16:154-7. Available from: http://www.journaldmims.com/text.asp?2021/16/1/154/322617
| Introduction|| |
Brachial plexus block is a reliable anesthetic technique for surgeries involving upper limb. It offers not only effective anesthesia during intraoperative period but also takes care of postoperative pain. Supraclavicular approach of the brachial plexus block is the most commonly performed approach. Ultrasound usage while performing blocks improved the success rate and also reduced the complications. It has now become routine practice of adding adjuvants to local anesthetics to improve the postoperative pain management.
Various drugs are used as adjuvants to local anesthetics which include opioids, α2 adrenoceptor agonists, dexamethasone, and magnesium. Among the available adjuvants, dexmedetomidine is an α2 adrenoceptor agonist gaining popularity due to its advantages such as shortened onset time, prolonged duration, and good quality of block with less complications.
This study was conducted to compare the block characteristics of 0.5% 30 ml ropivacaine alone with 0.5% 30 ml ropivacaine combined with 50 mcg of dexmedetomidine.
| Materials and Methods|| |
The study was conducted at a tertiary care setup after obtaining the institutional ethical committee clearance. 100 patients who were in the age group of 20–60 years, of either gender, f American Society of Anesthesiologists (ASA) Grade I–II, posted for elective upper limb surgeries were included in the study. Patients with infection at injection site, bleeding disorders, severe cardiac, respiratory, hepatic, renal, or endocrinological disease, allergic to study drugs, and preexisting peripheral neuropathy were excluded from the study.
Patients selected for the study received ultrasonography-guided supraclavicular brachial plexus block. They were randomized to receive either ropivacaine 0.5% 30 ml alone (Group A) or ropivacaine 0.5% 30 ml with dexmedetomidine 50 mcg (Group B).
All the patients were visited day before surgery to conduct preanesthetic evaluation. Patients were informed about the nature of the study, possible side effects, and remedies available. Written informed consent was obtained for the participation in the study was each individual. As per the institutional protocol, they were kept nil per oral from midnight.
Inside the operation room, patients were secured with intravenous line in the nonoperative limb and standard monitors such as pulse oximetry, noninvasive blood pressure, and electrocardiogram were connected and baseline readings were noted. All the patients were premedicated with injection midazolam 0.02 mg/kg intravenously.
Under all aspect precautions, supraclavicular plexus block was performed under ultrasound guidance. 30 ml of the study drug was given and spread of drug around the nerves observed.
Patients were evaluated for the onset of sensory and motor blockade. Sensory blockade was evaluated by pin prick method and considered complete when there was no response to stimulus in all three major nerve territories. Motor block was evaluated by asking the patient to rise hand above the head and considered complete when there was no movement of upper extremity. Onset time was considered as a time interval between completion of drug administration and complete sensory or motor block. Patients who had inadequate block were administered general anesthesia. During the surgeries, patients were monitored for nausea, vomiting, cardiovascular or central nervous system toxicity.
After completion of surgery, patients were shifted to the postoperative period and evaluated for pain using visual analog score every ½ h for the first 2 h and an hourly basis for the next 24 h. Patients with visual analog scale score >4 were administered rescue analgesia with injection diclofenac 75 mg intramuscularly. Duration of motor and sensory blockade was recorded. Duration of motor blockade was defined as the time from onset of motor block to complete recovery of motor block, and duration of sensory blockade was defined as the time from onset sensory block to complete resolution of sensation. Duration of analgesia was defined as the time from onset of sensory blockade to first request of rescue analgesia. All the data were noted in the study pro forma.
The sample size was calculated based on previous study. Student's t-test (two-tailed, independent) was used to find the significance of study parameters on continuous scale between the two groups on metric parameters. Sex ratio and ASA grade were compared using Chi-square test. P < 0.05 was considered statistically significant.
This study was approved by the Institutional Ethics Committee of Airforce Hospital KKD with ref no : IEC/AFH-KKD/04 dated : 7th June 2019.
| Results|| |
One hundred patients in the age group of 20–60 years, of ASA Grade I and II, undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block were included in this study. Patients were divided into two groups of 50 each: Group A (ropivacaine) and Group B (ropivacaine with dexmedetomidine) [Figure 1]. The two groups were similar with respect to age, weight, height, sex ratio, and ASA grades [Table 1]. The onset of sensory blockade in Group B was 17.32 ± 2.05 min and in Group A was 22.58 ± 1.75 min (P < 0.05) [Table 2]. The onset of motor blockade in Group B was 24.23 ± 5.83 min and in Group A was 28.61 ± 2.78 min (P < 0.05) [Table 2]. The duration of sensory blockade in Group B was 635.0 ± 27.12 and in Group A was 501.1 ± 33.14 min (P < 0.05) [Table 3]. The duration of motor blockade in Group B was 513.21 ± 26.14 min and in Group A was 402.17 ± 18.16 min (P < 0.05) [Table 3]. The total duration of analgesia in Group B was 338.16 ± 10 min and in Group A was 247.20 ± 12 (P < 0.05) [Table 3].
| Discussion|| |
Effective perioperative pain management is an important aspect of anesthetic practice. Regional anesthesia as a sole technique for surgery offers many advantages which include avoidance of polypharmacy, avoiding airway manipulation, minimal effects on cardiorespiratory system, extended analgesia even to the postoperative period, and better recovery., Along with local anesthetics, adjuvants play a very important role in effective control of pain. Local anesthetics alone have some limitations such as inadequate postoperative pain control, slow onset, and requirement of large doses. Adjuvants when used along with local anesthesia shorten the onset of block, prolong the duration of analgesia, affect spread of drug around nerves, and reduce the requirement of rescue analgesics.
The present study used ropivacaine which is a long-acting local anesthetic drug belongs to amide group. We used ropivacaine in a concentration of 0.5% which was based on the study conducted by Klein et al. They showed that increasing concentration of ropivacaine from 0.75% to 0.5% fails to improve onset or duration of block. Among available additives, dexmedetomidine is now emerging as a promising due to its multiple effects such as shortening the onset, prolonging the duration, and increasing the quality of analgesia without neurological sequelae.
Mechanism of analgesic effect of dexmedetomidine remains poorly understood. Many theories were postulated to explain the same which include supraspinal and spinal modulation of nociceptive signals, peripheral antinociception action, and reduction of calcium conductance into cells.
Our study compared supraclavicular brachial plexus block characteristics of ropivacaine with ropivacaine-dexmedetomidine combination. We found out that dexmedetomidine shortens the onset of block, prolongs the duration of analgesia, and increases the quality of block without complications.
We found out that the onset of sensory and motor blockade is shortened in ropivacaine-dexmedetomidine combination group when compared to ropivacaine group (17.32 ± 2.05 min, 24.23 ± 5.83 min vs. 22.58 ± 1.75 min, 28.61 ± 2.78 min) and it was statistically significant (P < 0.05). The finding of our study was comparable with study conducted by Gurajala et al. and Sudani et al., in whom onset of both sensory and motor blockade was faster in ropivacaine-dexmedetomidine group.
From our study, we found out that the duration of sensory blockade was prolonged in ropivacaine-dexmedetomidine group when compared to ropivacaine group (635.0 ± 27.12 vs. 501.1 ± 33.14) (P < 0.05), and it was statistically significant. In a study conducted by Kathuria et al. and Nema et al. also, they found out that the duration of sensory blockade was prolonged in ropivacaine-dexmedetomidine group significantly when compared to ropivacaine alone.
Duration of motor blockade was prolonged in ropivacaine-dexmedetomidine group when compared to ropivacaine group (513.21 ± 26.14 vs. 402.17 ± 18.16) (P < 0.05). These findings are comparable to the study conducted by Kathuria et al. and Khemka and Jadeja.
We found out that dexmedetomidine prolonged the time for first request of rescue analgesia thereby prolonged duration of analgesia. This result was comparable to Khemka and Jadeja and Gurajala et al.
There was no incidence of nausea, vomiting, respiratory depression, and bradycardia seen in either group.
| Conclusion|| |
We conclude that addition of dexmedetomidine to ropivacaine shortened the onset of block and prolonged the duration of block and duration of analgesia without any major side effects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]