Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

Abstract

Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints.

Materials and methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25), 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25), 30 ml of 0.325% bupivacaine + 1 ml (100 μg) dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR), systolic arterial blood pressure (SBP), and diastolic arterial blood pressure (DBP) were also monitored.

Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001), while the duration of blocks was significantly longer (P < 0.001) in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min), heart rate levels in group SD were significantly lower (P < 0.001). SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001). In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001) in group SD. The duration of analgesia (DOA) was significantly longer in SD group than S group (P < 0.001). Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups.

Conclusion: Dexmedetomidine added as an adjuvant to bupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia. Patients in group SD were adequately sedated (modified Ramsay Sedation Score, RSS = 2/6 or 3/6) with no adverse effects except bradycardia in one patient of group SD.

Keywords: Adjuvant; dexmedetomidine; effects; supraclavicular brachial plexus block.

Figure 1

(a) Mean heart rate values in the groups S (bupivacaine) and SD (bupivacaine + dexmedetomidine). Diamonds indicate time points of a statistically significant difference (P < 0.05) when the groups were compared. Triangles indicate very significant difference (P < 0.001). (b) Mean systolic (SBP) and diastolic (DBP) arterial pressures for the groups S (bupivacaine) and SD (bupivacaine + dexmedetomidine). Diamonds indicate the time points of a statistically significant difference (P < 0.05). Triangles indicate very significant difference (P < 0.001)

Figure 2

Comparison of mean onset time motor block (omb) and sensory block (osb); duration time motor block (dmb) and sensory block (dsb); and duration of analgesia (doa). The time difference between the two groups was statistically very significant (P < 0.001)