Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Brachial Plexus Block Using Supraclavicular Parasagittal Approach for Upper Limb Orthopedic Surgeries

Abstract

Background: Brachial plexus block is a key technique in anesthesiologist’s practice. Ropivacaine is a long acting local anaesthetic, Dexmedetomidine has been included as an adjuvant to enhance block duration. Aim: To elucidate the effect of addition of Dexmedetomidine to Ropivacaine in ultrasound guided parasagittal supraclavicular brachial plexus approach with respect to duration of analgesia, onset and duration of sensorimotor blockade. Methods: A randomized single blinded prospective clinical study was conducted among Forty patients of 20-50yrs, ASA Grade I and II, weighing >60kgs scheduled for elective upper limb orthopedic surgeries. Group RN received 25ml of 0.75% ropivacaine with 1ml normal saline, Group RD received 25ml of 0.75% ropivacaine with 1mcg/kg dexmedetomidine diluted to 1ml. Analgesic efficacy, sensorimotor blockade was determined. Statistical Analysis: Demographic and hemodynamic data was analyzed using student t-test. Unpaired t-test was used to analyze onset, duration of sensorimotor blockade and analgesic duration. Results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant. Results: Analgesic duration was prolonged in Group RD rather than Group RN (646.82 +/- 21.56min vs 484.78 +/- 15.52min). Group RD had rapid onset of sensory (7.4 +/- 1.02min vs 9.9 +/- 1.16min) and motor blockade (10.25 +/- 1.13min vs 13.28+/- 1.22min). Duration of sensory (536.62 +/- 9.61min vs 413.79 +/- 15.61min) and motor blockade (430.13 +/- 11.68min vs 298.12 +/- 15.36min) was enhanced in Group RD. Conclusion: Adding Dexmedetomidine to Ropivacaine provided superior analgesia along with rapid onset and longer duration of sensorimotor blockade.

Keywords

• Dexmedetomidine
• Ultrasound
• Supraclavicular brachial plexus block
• Ropivacaine
• Parasagittal