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Deciding the Better Dose- A Prospective Randomized Double Blind Study of Two Different Doses of Perineural Dexmedetomidine in Axillary Brachial Block

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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.

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An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation

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Vol 3 | Issue 2 | July-December 2022 | Page 88-92 | Trupti Pethkar, R. Janki

DOI: 10.13107/ijra.2022.v03i02.060

Authors: Trupti Pethkar [1], R. Janki [1]

[1] Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

[2] Critical Care Department, Caritas Hospital, Kottayam, Kerala, India.

Address of Correspondence
Dr. Trupti Pethkar,
Consultant Anesthesiologist, Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: truptipethkar@yahoo.co.in

Abstract

Background: Success of the brachial plexus block depends equally on the performer’s skill and the availability of specific equipments. Here, the efficacy of infraclavicular brachial plexus block was assessed using two different techniques.
Material and Methods: In 72 patients divided in equal groups, the time taken to perform the block, onset and degree of sensory and motor blockade, complications and supplements, if required were noted in patients undergoing arterio-venous fistula creation. An infraclavicular brachial plexus block was performed either with ultrasound only (group-A) or with ultrasound and nerve stimulation (group-B). Collected data underwent rigorous statistical analysis.
Results: Onset of sensory, motor blockade and block success achieved in both groups was statistically insignificant. Time taken for block administration and the mean time for complete sensory blockade were statistically significant.
Conclusion: Though time taken for the block administration was longer and complete sensory blockade was earlier by dual guidance, the block success rate and the degree of block were comparable in both the techniques. Dual modality blocks are challenging in view of obtaining an evoked motor response and visualization of the needle at the same time.
Keywords: Infraclavicular brachial plexus block, Sonosite, Peripheral nerve Stimulator

References

1. Emmannuel Dingemans, Stephan R. Williams, Genevie `ve Arcand, Philippe Chouinard, Patrick Harris, Monique Ruel, RN* Franc ¸ois Girard et al. Neurostimulation in ultrasound guided Infraclavicular Block: A Prospective Trial. Anaesth Analg 2007; 104; 1275-80.
2. Y. Gürkan, M. Tekin, S. Acar, M. Solak and K. Toker. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand 2010; 54: 403–407.
3. FMT Azmin & YC Choy. Regional infraclavicular blocks via the coracoid approach for below-elbow surgery: a comparison between ultrasound guidance with, or without, nerve stimulation, South Afr J Anaesth Analg 2013, 19(5):263-269.
4. Shrestha BR. Nerve Stimulation Under Ultrasound Guidance Expedites Onset of Axillary Brachial Plexus Block. J Nepal Health Res Counc 2011 Oct; 9(19):145-49.
5. Bloc S, Garnier T, Komly B, Leclerc P, Mercadal L, Morel B, Dhonneur G. Ultrasound-guided infraclavicular block: a preliminary study of feasibility. Ann Fr Anesth Reanim 2007; 26: 627–37.
6. Chan VWS, Perlas A, McCartney CJL, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007; 54: 176-182.
7. Richard Brull, MD Æ Mario Lupu, MD Æ Anahi Perlas, MD Æ Vincent W. S. Chan, MD Æ Colin J. L. McCartney, MB. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance.Can J Anaesth 2009 Nov; 56(11): 812-8.

How to Cite this Article: Pethkar T, Janki R | An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 88-92.

(Abstract Text HTML)    (Download PDF)