Upper Limb Surgeriesunder Brachial Plexus Block Using Infusion of Dexmedetomidine or Propofolfor Monitored Anaesthesia Care - A Comparative Study

Background: Brachial plexus block is widely used for upper limb surgeries but intraoperatively, patients remain awake and anxious. This study has compared the intraoperative sedation of dexmedetomidine infusion versus propofol infusion during upper limb surgeries by using monitored anesthesia care. Subjects and Methods: Sixty adult consenting patients of ASA physical status I to III of either gender were enrolled and brachial plexus block was established with 20 mL of 0.5% bupivacaine using ultrasound. Patients were randomized into two equal groups of 30 patients each to receive either dexmedetomidine1g/kg over 10 min, followed by maintenance fusion of 0.4 g/kg/h (Group D) or propofol infusion of 75g/kg/min over 10 min, followed by 50g/kg/min (Group P). Intraoperative sedation and duration of postoperative analgesia were primary objectives. The hemodynamic changes, respiratory depression, recovery from sedation or any adverse events were noted as secondary outcomes. Results: Ultrasound helped to observe the spread of local anesthetic agent at brachial plexus. The patients of propofol group had faster onset with early recovery from sedation but sedation in patients of dexmedetomidine was clinically better with statistically significant difference. Duration of postoperative analgesia was also significantly enhanced with dexmedetomidine infusion. In propofol group, the blood pressure and heart rate remained lower when compared to dexmedetomidine infusion. There was no episode of respiratory depression in any patient. Conclusion: Dexmedetomidine infusion was better due to its stable hemodynamic profile, better intraoperative sedation and enhanced duration of postoperative analgesia without respiratory depression during upper limb surgeries.