COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE AND BUPIVACAINE ALONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

MOHD MUSHEER KHAN; PRASHI SHARMA; SUSHIL KUMAR; VIVEK BADADA; SANJAY MELVILLE MASIH

doi:10.22159/ajpcr.2023.v16i11.49720

Authors

MOHD MUSHEER KHAN Department of Anaesthesiology, F.H. Medical College and Hospital, Agra, Uttar Pradesh, India.
PRASHI SHARMA Department of Anaesthesiology, F.H. Medical College and Hospital, Agra, Uttar Pradesh, India
SUSHIL KUMAR Department of Anaesthesiology, F.H. Medical College and Hospital, Agra, Uttar Pradesh, India
VIVEK BADADA Department of Anaesthesiology, F.H. Medical College and Hospital, Agra, Uttar Pradesh, India.
SANJAY MELVILLE MASIH Department of Anaesthesiology, F.H. Medical College and Hospital, Agra, Uttar Pradesh, India

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i11.49720

Keywords:

Brachial plexus block, Upper limb surgeries, Bupivacaine, Dexmedetomidine

Abstract

Objective: The objective is to compare the efficacy of bupivacaine with dexmedetomidine and bupivacaine alone when used for supraclavicular brachial plexus block in patients undergoing upper limb surgeries.

Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. 80 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were included on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups depending on whether they received only Bupivacaine (Group B) or Bupivacaine and Dexmedetomidine (Group BD) for supraclavicular block. The onset and duration of sensory as well as motor blockade, intensity of Pain as assessed by Visual Analog Score, requirement of rescue analgesia, hemodynamic profile, and side effects were compared in both the groups. For statistical purpose p<0.05 was taken as statistically significant.

Results: Group BD exhibited significantly faster onset and longer duration of sensory blockade compared to Group B. Group BD also showed significantly faster onset and longer duration of motor blockade compared to Group B. Moreover, Group BD had significantly longer analgesia duration (614.84±52.02 min) compared to Group B (352.62±32.46 min). The hemodynamic parameters, including mean heart rate and mean arterial pressure, were not significantly different between the groups. In addition, side effects such as bradycardia and hypotension were observed in Group BD, but these differences were not statistically significant.

Conclusion: Dexmedetomidine, when used as an adjuvant to bupivacaine during supraclavicular brachial plexus block in upper limb surgeries provided longer-lasting analgesia, and reduced pain intensity as compared to Bupivacaine alone with a comparable side effect profile.

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References

Dohlman LE, Kwikiriza A, Ehie O. Benefits and barriers to increasing regional anesthesia in resource-limited settings. Local Reg Anesth 2020;13:147-58. doi:10.2147/LRA.S236550.

Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: Review and current practice. Acta Anaesthesiol Belg 2012;63:15-21.

Stone MB, Wang R, Price DD. Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med 2008;26:706-10. doi:10.1016/j.ajem.2007.09.011

Paganelli MA, Popescu GK. Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses. J Neurosci 2015;35:831-42. doi:10.1523/JNEUROSCI.3578-14.2015

Nilsson J, Elinder F, Arhem P. Mechanisms of bupivacaine action on Na+ and K+ channels in myelinated axons of Xenopus laevis. Eur J Pharmacol 1998;360:21-9. doi:10.1016/s0014-2999(98)00631-1

Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as an adjuvant in peripheral nerve block. Drug Des Devel The 2023;17:1463-84. doi:10.2147/DDDT.S405294

Zhang X, Wang D, Shi M, Luo Y. Efficacy and safety of dexmedetomidine as an adjuvant in epidural analgesia and anesthesia: A systematic review and meta-analysis of randomized controlled trials. Clin Drug Investig 2017;37:343-54. doi:10.1007/s40261-016-0477-9

Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015;9:148-54. doi:10.4103/1658-354X.152841

Schwerin S, Westphal C, Klug C, Schneider G, Kreuzer M, Haseneder R, et al. Sedative properties of dexmedetomidine are mediated independently from native thalamic hyperpolarization-activated cyclic nucleotide-gated channel function at clinically relevant concentrations. Int J Mol Sci 2022;24:519. doi:10.3390/ijms24010519

Chrysostomou C, Schmitt CG. Dexmedetomidine: Sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol 2008;4:619-27. doi:10.1517/17425255.4.5.619

Zhang P, Liu S, Zhu J, Rao Z, Liu C. Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: A prospective randomized study. Reg Anesth Pain Med 2019;44:917-22.

Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology 2008;109:502-11. doi:10.1097/ALN.0b013e318182c26b

Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2014;30:36-40. doi:10.4103/0970-9185.125701

Aksu R, Bicer C. Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block. Clin Invest Med 2017;40:E111-6. Published 2017 Jun 26. doi:10.25011/cim.v40i3.28390

Sane S, Shokouhi S, Golabi P, Rezaeian M, Kazemi Haki B. The effect of dexmedetomidine in combination with bupivacaine on sensory and motor block time and pain score in supraclavicular block. Pain Res Manag 2021;2021:8858312. Published 2021 Apr 10. doi:10.1155/2021/8858312

Waindeskar V, Jain A, Kumar J, Pandey A, Songir S. Alpha 2 agonist dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Int J Med Res Rev 2016;4:855-60. doi:10.17511/ ijmrr.2016.i05.33

Nazir N, Jain S. A randomized controlled trial study on the effect of adding dexmedetomidine to bupivacaine in supraclavicular block using ultrasound guidance. Ethiop J Health Sci 2016;26:561-6. doi:10.4314/ ejhs.v26i6.9

Hussain N, Grzywacz VP, Ferreri CA, Atrey A, Banfield L, Shaparin N, et al. Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in brachial plexus block: A systematic review and meta-analysis of 18 randomized controlled trials. Reg Anesth Pain Med 2017;42:184-96. doi:10.1097/AAP.0000000000000564

Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: A randomized controlled trial. Anesth Analg 2015;121:1655-60. doi:10.1213/ANE.0000000000001006

Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017;96(4):e5846. doi:10.1097/MD.0000000000005846