Pain relief after ambulatory hand surgery: A comparison between dexmedetomidine and clonidine as adjuvant in axillary brachial plexus block: A prospective, double-blinded, randomized controlled study
A Das1, S Dutta2, S Chattopadhyay1, S Chhaule1, T Mitra3, R Banu4, P Mandal5, M Chandra2
1 Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
2 Department of Orthopedics, R. G. Kar Medical College, Kolkata, West Bengal, India
3 Department of Anaesthesiology, Murshidabad Medical College, Berhampore, West Bengal, India
4 Department of G and O, Berhampore, West Bengal, India
5 Department of G and O, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
174, Gorakshabashi Road, Royal Plaza Apartment, 4th Floor, Flat No-1, Nagerbazar, Kolkata - 700 028, West Bengal
Source of Support: None, Conflict of Interest: None
Background: For ages various adjuvants have been tried to prolong axillary brachial plexus block. We compared the effect of adding dexmedetomidine versus clonidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.
Materials and Methods: A total of 90 patients (20-40 years) posted for ambulatory elective hand surgery under axillary brachial plexus block were divided into two equal groups (groups ropivacaine dexmedetomidine [RD] and ropivacaine clonidine [RC]) in a randomized, double-blind fashion. In group RD (n = 45) 30 ml 0.5% ropivacaine + 100 μg of dexmedetomidine and group RC (n = 45) 30 ml 0.5% ropivacaine + 75 μg clonidine were administered in axillary plexus block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient.
Results: Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group RC. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group RC. Postoperative VAS value at 18 h were significantly lower in group RD (P < 0.05). Intraoperative hemodynamics were insignificantly lower in group RD (P < 0.05) without any appreciable side-effects.
Conclusion: It can be concluded that adding dexmedetomidine to axillary plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects.