Key result
Dexmedetomidine added to bupivacaine yields ~44% faster sensory block onset and prolongs analgesia vs clonidine.
Why the study?
Alpha 2 agonists are of new interest as adjuvants to bupivacaine for supraclavicular brachial plexus block in upper limb orthopedic procedures, but comparative data between dexmedetomidine and clonidine are needed.
Does dexmedetomidine compared to clonidine as an adjuvant to bupivacaine improve block characteristics and prolong analgesia in patients undergoing upper limb orthopedic procedures?
RCT (n=60)
Randomized
No
Does dexmedetomidine compared to clonidine as an adjuvant to bupivacaine improve block characteristics and prolong analgesia in patients undergoing upper limb orthopedic procedures?
Absolute Event Rate: 4.7% vs 8.47%
p-value: p=<0.001
Dexmedetomidine is a more effective adjuvant to bupivacaine than clonidine for supraclavicular brachial plexus blocks, providing faster onset and longer duration of analgesia.
May favor dexmedetomidine over clonidine as bupivacaine adjuvant; leaves open confirmation in randomized trials before changing practice.
Background: Supraclavicular brachial plexus block is used commonly for upper limb orthopedic procedures. Among the adjuvants used to improve the quality of block induced by bupivacaine the alpha 2 agonists are of new interest. This study was done to compare dexmedetomidine and clonidine as adjuvants to bupivacaine for supraclavicular brachial plexus block in upper limb orthopedic surgeries.Methods: 60 ASA I/II patients aged between 20 and 50 years undergoing upper limb orthopedic procedures were selected and divided into two groups of 30 each. Group C received 35 ml of 0.375% Bupivacaine and clonidine 2µg/kg while Group D received 35 ml of 0.375% bupivacaine and dexmedetomidine 2 µg/kg. Onset time to sensory and motor blockade, vitals, complete duration of motor and sensory block, total duration of analgesia and side effects were noted.Results: The mean time of onset for sensory block and motor block in Group D was lower when compared to Group C. Except at 5th minute the pulse rate and mean arterial pressure were lower in Group D when compared to Group C. The mean time for total duration of sensory block and motor block was more in Group D when compared to Group C. The total duration of analgesia was higher in Group D than in Group C.Conclusions: The addition of dexmedetomidine to bupivacaine during supraclavicular brachial plexus block produces a shorter onset of time to sensory and motor block with prolonged duration of analgesia when compared to clonidine added to bupivacaine.
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Kirubahar et al. (2016) conducted an RCT in Upper limb orthopedic procedures (n=60). Dexmedetomidine vs. Clonidine 2 µg/kg was evaluated on Onset time of sensory block (minutes) (p=<0.001). Dexmedetomidine added to bupivacaine significantly shortened the onset time of sensory block (4.7 vs 8.47 minutes) and prolonged the duration of analgesia (666.27 vs 375.23 minutes) compared to clonidine.
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