Key result
Dexmedetomidine prolongs sensory block by ~171 minutes and extends postoperative analgesia vs clonidine.
Why the study?
Dexmedetomidine is more selective for α2-adrenoceptors than clonidine, but their comparative efficacy as adjuvants to bupivacaine in supraclavicular brachial plexus block needed evaluation.
Does dexmedetomidine compared to clonidine prolong block duration and postoperative analgesia when added to bupivacaine in patients undergoing elective orthopedic surgeries under supraclavicular brachial block?
RCT (n=60)
Double-blind
Randomized
No
Does dexmedetomidine compared to clonidine prolong block duration and postoperative analgesia when added to bupivacaine in patients undergoing elective orthopedic surgeries under supraclavicular brachial block?
Absolute Event Rate: 406.7% vs 235.9%
p-value: p=<0.001
Dexmedetomidine added to bupivacaine for supraclavicular brachial plexus block significantly prolongs motor and sensory block and postoperative analgesia compared to clonidine.
Supports dexmedetomidine over clonidine to prolong sensory block and analgesia in supraclavicular blocks; extends comparative RCT evidence on alpha-2 agonists.
BACKGROUND: Dexmedetomidine, a potent α2-adrenoceptor agonist, is approximately eight-times more selective towards the α2-adrenoceptor than clonidine.AIM: Comparison of clonidine and dexmedetomidine as an adjuvant to local anaesthetic in supraclavicular brachial block. MATERIALS AND METHODS:Sixty patients of age group 18-60 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into two equal groups in a randomized, double-blinded fashion.In group C (n = 30), 30 ml of 0.25% bupivacaine+clonidine 1µg/kg; and in group D (n=30), 30 ml of 0.25% bupivacaine+ dexmedetomidine 1µg/kg were given.Onset of motor and sensory block, duration of sensory and motor block, quality of block, and duration of postoperative analgesia were recorded.RESULTS: Demographic data and surgical characteristics were similar in both groups.The sensory and motor block onset time was same in both groups (P >0.05).Sensory and motor blockade durations were longer in group D than in group C (P < 0.001).Duration of postoperative analgesia was longer in group D than in group C (P < 0.001).The 24 h Numerical Rating Pain score was more in Group D as compared to Group C. The quality of anaesthesia was excellent in group D as compared to group C (P <001).The mean pulse rate and mean blood pressure levels at different time intervals were statistically insignificant between the groups (P > 0.05).CONCLUSIONS: Dexmedetomidine added to bupivacaine for supraclavicular brachial plexus block prolongs the duration of the motor and sensory block and the duration of postoperative analgesia significantly as compared to clonidine.
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Munshi et al. (2015) conducted an RCT in Elective orthopaedic surgeries of upper limb (n=60). Dexmedetomidine vs. Clonidine 1 µg/kg was evaluated on Total duration of sensory block (min) (p=<0.001). Dexmedetomidine added to bupivacaine for supraclavicular brachial plexus block significantly prolonged the duration of sensory block (406.7 vs 235.9 min) and postoperative analgesia compared to clonidine.
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