Deciding the Better Dose- A Prospective Randomized Double Blind Study of Two Different Doses of Perineural Dexmedetomidine in Axillary Brachial Block
Vol 3 | Issue 2 | July-December 2022 | Page 83-87 | Sheetal Y Chiplonkar, Jalpa A Kate, Dinesh B Vadranapu, Pratibha Toal
DOI: 10.13107/ijra.2022.v03i02.059
Authors: Sheetal Y Chiplonkar [1], Jalpa A Kate [1], Dinesh B Vadranapu [2], Pratibha Toal [1]
[1] Department of Anaesthesiology, BARC Hospital, Anushaktinagar, Mumbai, Maharashtra, India.
[2] Department of Critical Care, P.D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Jalpa A Kate,
Consultant, Department of Anaesthesiology, BARC Hospital, Anushaktinagar, Mumbai, Maharashtra, India.
E-mail: dr.japs@gmail.com
Abstract
Background: Axillary brachial plexus block is generally regarded as the safest and reliable technique for forearm and hand surgeries. Dexmedetomidine, a potent alpha (α)-2-adrenergic receptor agonist when used as an additive in any peripheral nerve block can improve quality of block and postoperative analgesia, though uncertainity prevails regarding the dose in patients undergoing hand and forearm surgeries.
Methods: In this prospective, randomized, comparative, double blind study, 80 patients were included. Each participant fulfilling the inclusion criteria then received axillary brachial plexus block using 15cc 2% lignocaine with adrenaline (1:200000)and 0.5% bupivacaine 5cc mixed with dexmedetomidine either 0.5 µg /kg (group A) or 1 µg /kg ( group B)in 2cc normal saline. Duration of post-operative analgesia was the primary outcome.
Result: Duration of analgesia was significantly prolonged in group B (493.77±115.62 min) compared to group A (434.62±45.18 min, P <0.01).
Conclusion: Between the two doses of dexmedetomidine, block characteristics and analgesia obtained were better with higher dose (1 µg/kg) but chances of side effects like bradycardia increased. Hence 0.5 µg/kg can be a better dose with improved block characteristics yet negligible side effects.
Keywords: Brachial plexus block, Dexmedetomidine Perineural, Peripheral nerve stimulator, Ultrasonography
References
1. Thakur A, Singh J, Kumar S, Rana S, Sood P, Verma V. Efficacy of Dexmedetomidine in two Different Doses as an Adjuvant to Lignocaine in Patients Scheduled for Surgeries under Axillary Block. J Clin Diagn Res JCDR. 2017; 11(4):UC16–21.
2. Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM. Peripheral Nerve Blockade with Long-Acting Local Anesthetics: A Survey of The Society for Ambulatory Anesthesia. Anesth Analg. 2002; 94(1):71–76.
3. Sanghvi KS, Shah VA, Patel KD. Comparative study of bupivacaine alone and bupivacaine along with buprenorphine in axillary brachial plexus block: a prospective, randomized, single blind study. Int J Basic Clin Pharmacol. 2013; 2(5):640–644.
4. Biradar PA, Kaimar P, Gopalakrishna K. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study. Indian J Anaesth. 2013; 57(2):180–4.
5. Lee AR, Yi H, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block. Can J Anesth Can Anesth. 2012; 59(1):21–27.
6. Rojas González A. Dexmedetomidine as an adjuvant to peripheral nerve block. Rev Soc Esp Dolor 2019; 26(2):115-117.
7. Cai, H., Fan, X., Feng, P, et al. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials. BMC Anesthesiol 21, 233 (2021).
8. Jie F, Yuncen S, Fang D et al. The effect of perineural dexamethasone on rebound pain after ropivacaine single injection nerve block: A randomised controlled trial. BMC Anesthesiology 2021; 21(1) doi: 10.1186/s12871-021-01267-z.
9. Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2014; 30(1):36–40.
10. Gupta A, Mahobia M, Narang N, Mahendra R. A comparative study of two different doses of dexmedetomidine as adjunct to lignocaine in intravenous regional anaesthesia of upper limb surgeries. Int J Sci Study. 2014; 2(3):53–62.
11. Kaygusuz K, Kol IO, Duger C, Gursoy S, Ozturk H, Kayacan U, et al. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block. Curr Ther Res Clin Exp. 2012; 73(3):103–11.
12. Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current. Anesthesiology. 2011; 115(4):836–43.
13. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine Added to Levobupivacaine Prolongs Axillary Brachial Plexus Block. Anesth Analg. 2010 Dec; 111(6):1548–1551.
14. Bangera A, Manasa M, Krishna P. Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block: A prospective randomized double-blinded clinical trial. Saudi J Anaesth. 2016; 10(1):38–44.
15. Koraki E, Stachtari C, Kapsokalyvas I, Stergiouda Z, Katsanevaki A, Trikoupi A. Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block. J Clin Pharm Ther. 2018; 43(3):348–52.
16. Paranjpe JS. Dexmedetomidine: Expanding role in anesthesia. Med J Dr DY Patil Univ. 2013; 6(1):5.
17. Leudi MM, Upadek V, Vogt AP, Steinfeldt T, Eichenberger U, Sauter AR. Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks. SciRep.2019 24:9(1):9178.doi:10.1038/s41598-019-45700-3.
| How to Cite this Article: Chiplonkar SY, Kate JA, Vadranapu DB, Toal P| Deciding the Better Dose- A Prospective Randomized Double Blind Study of Two Different Doses of Perineural Dexmedetomidine in Axillary Brachial Block | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 83-87. |
