Key result
Adding 1 µg/Kg clonidine to 0.5% ropivacaine for supraclavicular brachial plexus block significantly prolonged the duration of sensory blockade compared to adding 5 µg/mL epinephrine.
Why the study?
Although epinephrine is commonly used to improve regional anaesthesia duration, the comparative effects of adding clonidine versus epinephrine to ropivacaine for supraclavicular brachial plexus block were unclear.
Does the addition of clonidine compared to epinephrine to ropivacaine improve the duration of analgesia in patients undergoing upper limb surgeries?
RCT (n=40)
Does the addition of clonidine compared to epinephrine to ropivacaine improve the duration of analgesia in patients undergoing upper limb surgeries?
The addition of clonidine to ropivacaine for supraclavicular brachial plexus block provides a longer duration of analgesia compared to epinephrine.
Clonidine addition to ropivacaine prolongs sensory blockade versus epinephrine; extends RCT evidence favoring alpha-2 agonists as adjuvants in supraclavicular blocks.
BACKGROUND To improve the time of regional anaesthesia many methods have been used. Epinephrine continues to be the most commonly used drug for this purpose. We wanted to compare the effects of alpha-adrenergic agonists clonidine and adrenaline as an adjuvant to ropivacaine in blocking brachial plexus by the supraclavicular approach in patients undergoing upper limb surgeries. METHODS It is a prospective randomised comparative study conducted for 18 months in 40 patients randomly divided into group RA and group RC, conducted on American Society of Anesthesiology (ASA) I and II patients undergoing upper limb surgeries under supraclavicular brachial plexus block. In group RA 30 mL of 0.5 % ropivacaine with 5 microgram / mL of epinephrine was given and in group RC 30 mL of 0.5 % ropivacaine with 1 microgram / Kg of clonidine was given. RESULTS On comparing effects of added alpha-adrenergic agonists clonidine and epinephrine to ropivacaine for supraclavicular brachial plexus block, it was found that there was no significant difference in the onset of the sensory blockade and motor blockade in the two groups. Duration of sensory blockade was significantly more in the clonidine with ropivacaine group when compared with the epinephrine and ropivacaine. There was no significant difference in haemodynamic responses between the two groups. CONCLUSIONS Supraclavicular approach brachial plexus block is effective in terms of cost and performance, and the margin of safety along with good postoperative analgesia. Hence, it can be concluded that the addition of 1 µg / Kg of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block provides a longer duration of analgesia as compared to 5 µg / mL of epinephrine added to 0.5 % ropivacaine.
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Das et al. (2021) conducted an RCT in Upper limb surgeries (n=40). Clonidine vs. Epinephrine (5 microgram / mL added to 30 mL of 0.5 % ropivacaine) was evaluated on Onset and duration of sensory and motor blockade. Adding 1 µg/Kg clonidine to 0.5% ropivacaine for supraclavicular brachial plexus block significantly prolonged the duration of sensory blockade compared to adding 5 µg/mL epinephrine.
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