DOI: http://dx.doi.org/10.18203/2349-3933.ijam20175878

Comparative study between dexamethasone and dexmedetomidine in supraclavicular block

Mandeep Kaur, Amit Lakhani, A.M. Hashia

Abstract


Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an α-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine.

Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50μg of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded.

Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups.

Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.


Keywords


Bupivacaine, Dexmedetomidine, Dexamethasone, Lignocaine, Peripheral nerve stimulator, Supraclavicular brachial plexus block

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References


Raimo V, Juha M, VeijoS, Leena N, Virtanen R. Charecterisation of selectivity, specificity & potency of dexmedetomidine as alpha 2 adrenoceptor agonist. EUR J Pharmacol. 1988;150:9-14.

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. Anesthesiol. 2008;109:502-11.

Kanazi GB, Aouad MT, Bbaur JA, Khoury SL, Jazzar AL. Effects of low dose dexmedetomidine or clonidine on characteristics of spinal block. Acta Anaesthesiol Scand. 2006;50:222-7.

Memis D, Turan A, Karamanlioglu B, Pamukcu Z, Kurt I. Adding dexmedetomidine to lignocaine for IVRA. Anesth Analg. 2004;98:835-40.

Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to Levobupivacaine prolongs axillary brachial plexus block. Anaesth Analg. 2010;111:1548-51.

Castillo I, Curtley J, Hotz J. Glucocorticoids prolong rat sciatic nerve blockade in bupivacaine microspheres. Anesthesiol. 1996;85:1157-66.

Drogger C, Benziger D, Gao F, Berde CB. Prolonged intercostal nerve blockade in sheep using controlled release of bupivacaine and dexamethasone from polymer microspheres. Anesthesiol. 1998;89:969-74.

Yoshitomi T, Kohjitani A, Maeda S, Higchi H. Dexmedetomidine enhances the local anaesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008;107:96-101.

Golwala MP, Swadia VN, Dhimar AA, Sridhar NV. Pain relief by dexamethasone as an adjuvant to local anaesthetic in supraclavicular brachial plexus block. J Anesth Clin Pharmacol. 2009:25(3):285-88.

Verma NK, Ranjan A. A clinical comparison of Dexmedetomidine and Dexamethasone as adjuvant to Ropivacaine in Supraclavicular brachial plexus blocks for upper arm surgeries. Int J Adv Res Biol Sci. 2016;3(7):56-61.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. BUMC proceedings. 2001;14:13-21.

El-hakim M, Ali NM, Rasheed. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth. 2003;50;392-97.

Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative pain and emesis. Br J Anaesth. 1998;80;85-6.