Email this article Retrospective comparison of anesthetic effects of bupivacaine and bupivacaine + dexmedetomidine in infraclavicular brachial plexus block in upper limb surgery
DOI: https://doi.org/10.20528/cjpm.2025.03.003
View Counter: Abstract | 269 times | ‒ Full Article | 80 times |
Full Text:
PDFAbstract
Background: The objective of this study was to evaluate the anesthetic efficacy of dexmedetomidine as an adjuvant to bupivacaine in infraclavicular brachial plexus blocks administered for surgical procedures involving the hand and forearm.
Materials and Methods: 84 patients, aged between 18-70 years, who underwent elective hand and forearm surgery in between January 2021 and July 2021, had American Society of Anesthesiologists (ASA) classification I-II, and were anesthetized with ultrasound-guided infraclavicular brachial plexus block were included in the study. Group B (n=42): 20 ml bupivacaine 0.5%+20 ml SF, Group B+D (n=42): 20ml bupivacaine 0.5% + 1 mcg/kg dexmedetomidine diluted to a volume of 20 mL was selected from the patients who underwent block. Demographic information of the patients were taken from the preoperative anesthesia evaluation form and recorded. From the information recorded in the patient follow-up form, peak heart rate, mean arterial pressure, oxygen saturation percentage, Visual Analogue Scale (VAS) scores, pinprick test score and Bromage score were recorded as study data.
Results: Compared to group B, the onset time of sensory and motor blockade was statistically significantly earlier and the duration of sensory block, motor block and analgesia was statistically significantly longer in group B+D (p<0.05). In Group B+D, VAS score was statistically significantly lower at 10th, 20th, 8th and 12th hours (p<0.05).
Conclusions: The addition of 1 mcg/kg dexmedetomidine to 20 ml of 0.5% bupivacaine in infraclavicular brachial plexus block was found to significantly accelerate the onset of sensory and motor block, and to extend the duration of motor block, sensory block, and postoperative analgesia.
Keywords
References
Chin KJ, Singh M, Velayutham V, Chee V. Infraclavicular brachial plexus block for regional anaesthesia of the lower arm. Anesth Analg. 2010;111(4):1072.
Macfarlane A, Anderson K. Infraclavicular brachial plexus blocks. Cont Educ Anaesth Crit Care Pain. 2009;9(5):139–143.
Sandhu NS, Manne JS, Medabalmi PK, Capan LM. Sonographically guided infraclavicular brachial plexus block in adults: A retrospective analysis of 1146 cases. J Ultrasound Med. 2006;25(12):1555–1561.
Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94(1):7–17.
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 rats. Anesthesiology. 2008;109(3):502–511.
Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: Are they clinically different?. Best Pract Res Clin Anaesthesiol. 2005;19(2):247–268.
Sreeja R, Mathew A, Velayuden M. Effect of added alpha 2 agonists with local anaesthetic in infraclavicular brachial plexus block: A comparative study between dexmedetomidine and clonidine. Anesth Essays Res. 2020;14(4):638–643.
Yaghoobi S, Shahamat H, Alizadeh A, Khezri MB. Comparing postoperative analgesic effect of dexmedetomidine or dexamethasone added to lidocaine through infraclavicular block in forearm surgery. Clin J Pain. 2019;35(9):766–771.
Song JH, Shim HY, Lee TJ, Jung JK, Cha YD, Lee DI, et al. Comparison of dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in brachial plexus block. Korean J Anesthesiol. 2014;66(4):283–289.
Hussain N, Grzywacz VP, Ferreri CA, 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(2):184–196.
Schnabel A, Reichl SU, Weibel S, Kranke P, Zahn PK, Pogatzki-Zahn EM, et al. Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2018;35(10):745–758.
Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am. 2015;95(2):301–318.
Reisli R, Akkaya ÖT, Arıcan Ş, Can ÖS, Çetingök H, Güleç MS, et al. Akut postoperatif ağrının farmakolojik tedavisi: Türk Algoloji-Ağrı Derneği klinik uygulama kılavuzu. Agri. 2021;33:1–51. (in Turkish)
Lomate PA, Mane MV. Efficacy of multimodal analgesia with perineural buprenorphine or dexmedetomidine for surgeries performed under ultrasound-guided infraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2020;36(1):66–71.
Safa B, Flynn B, McHardy PG, Kiss A, Haslam L, Henry PD, et al. Comparison of the analgesic duration of 0.5% bupivacaine with 1:200,000 epinephrine versus 0.5% ropivacaine versus 1% ropivacaine for low-volume ultrasound-guided interscalene brachial plexus block: A randomized controlled trial. Anesth Analg. 2021;1129–1137.
Desai N, Kirkham KR, Albrecht E. Local anaesthetic adjuncts for peripheral regional anaesthesia: A narrative review. Anaesthesia. 2021;76(Suppl 1):100–109.
Rao S, Rajan N. Dexmedetomidine as an adjunct for regional anesthetic nerve blocks. Curr Pain Headache Rep. 2021;25(2):8.
Ammar AS, Mahmoud KM. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi J Anaesth. 2012;6(2):109–114.
Mirkheshti A, Saadatniaki A, Salimi A, Rasi M, Memary E, et al. Effects of dexmedetomidine versus ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block. Anesth Pain Med. 2014;4(3):17620.
Das B, Lakshmegowda M, Sharma M, Mitra S, Chauhan R. Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study. Rev Esp Anestesiol Reanim. 2016;63(3):135–140.
Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010;111(6):1548–1551.
Laycock H, Bantel C. Objective assessment of acute pain. J Anesth Clin Res. 2016;7(6):1000630.
Bahraini A, Banerjee O, Ra J. Bradycardia resulting in cardiac arrest in a critically ill patient receiving dexmedetomidine. Trauma Case Rep. 2021;36:100548.
Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2017;118(2):167–181.
Cai H, Fan X, Feng P, Wang X, Xie Y. 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. 2021;21(1):233.
Zhang H, Zhou F, Li C, et al. Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: An in vivo and in vitro experimental study. PLoS One. 2013;8(2):e55556.
Tüfek A, Kaya S, Tokgöz O, Firat U, Evliyaoğlu O, Çelik F, et al. The protective effect of dexmedetomidine on bupivacaine-induced sciatic nerve inflammation is mediated by mast cells. Clin Invest Med. 2013;36(2):1–8.
Refbacks
- There are currently no refbacks.
