Comparison of Dexmedetomidine with Clonidine as adjuvant to 0.25% Bupivacaine in Ultra Sound Guided Supraclavicular Brachial Plexus Block

10 INDIAN JOURNAL OF APPLIED RESEARCH Volume 7 | Issue 5 | May 2017 | 4.894 ISSN 2249-555X | IF : | IC Value : 79.96 e demographic variables such as age, weight, ASA status and duration of surgery was comparable in both the groups. (P>0.05) (Table 1). e mean time of onset of sensory and motor block was significantly faster in Group BD (8.8±0.91min, 11.36±0.952) than Group BC (11.14±1.13min, 13.6±1.11), (p <0.001). e mean duration of sensory block in group BC was 7.06±0.664hrs and in group BD was 9.3±0.667hrs. (p < 0.001). e mean duration of motor block in group BC was 6.66±0.657hrs and in group BD was 8.5±0.692hrs (p <0.001) (Fig 1). e mean duration of analgesia in group BC was 6.25 ± 0.96 compared to 7.86 ± 1.23 hours in group BD (p < 0.0001) (Table 2). ere were no significant side effects or complications in any of the patients. DISCUSSION: e α2agonists have peripheral analgesic and anaesthetic actions that are independent of α2receptors. Both dexmedetomidine and clonidine have been successfully used in central neuraxial and peripheral nerve blocks with good results Kanazi et al<Brummet et al,CongedoE et al and Esmaoglu A et al. We decided to compare the effects of 1 μg /kg of dexmedetomidine and clonidine as adjuvants to 0.25% bupivacaine in supraclavicular block. We used a dose of 1 μg /kg of both dexmedetomidine and clonidine 8 9 10 like others S Swami et al, Preeti More et al, Jeby mathew et al. since the equipotent doses of these drugs as adjuvants in brachial plexus blocks have not been documented. In our study, it was found that the onset of sensory block and motor block were significantly faster in patients who received dexmedetomidine than clonidine. is is in conjunction with others. 8 9 11 S Swami et al, Preeti More et al, Bajwa SJ et al. e α2agonists causes faster sensory and motor onset by reducing norepinephrine release that causes inhibition of nerve fiber action potential. is effect is supposed to be not mediated through α2receptors. 12 9 Previous studies S Swami8et al Archana Tripathi et al, Preeti More 13 et al Munshi et al have found the prolongation of sensory and motor block with dexmedetomidine when compared with clonidine. Our study also confirmed these findings. e prolongation of sensory and motor block is due to the reduction of the peak amplitude of compound action potential, the effect of which is maximum with as 14 demonstrated by Kosugi et al. Other studies have found that the dexmedetomidine group had longer duration of analgesia than clonidine group for brachial plexus 12 9 block S Swami8 et al, Archana Tripathi et al, Preeti More et al 13 Munshi et al. Similar results have been found in Epidural 11 anaesthesia. Bajwa SJ et al. Our study also concurs with the above findings. e reasons have already been elucidated above. All the patients in both the groups were adequately sedated though the dexmedetomidine group had slightly higher sedation than clonidine group. is may be due to the systemic absorption of the drug that causes sedation by their action on locus coeruleus. Other 9 studies concur with the above findings S Swami8et al, Preeti More et al. ough there was a fall in Heart rate and Systolic blood pressure, none of the patients required treatment. ese findings are in 8 9 conjunction with other studies. S Swami et al, Preeti More et al. Conclusion: To conclude, we would like to state that dexmedetomidine shortens the time of onset and prolongs the duration of sensory and motor block as compared with clonidine when used as an adjuvant to Bupivacaine in supraclavicular block. References: 1. Koj J, Yatindra KB, Nidhi BP. Brachial plexus block with midazolam and bupivacaine improves analgesia. Can J Anesth 2005; 52:822-6. 2. Popping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anaesthetic for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology 2009; 111:406-15. 3. El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anaesth 2000; 47:9624. Kanazi GE, Aouad MT, Jabbour-K Houry SI, Al Jazzar MD, Alameddine MM, Al-aman R, Bulbul M, Baraka AS. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesth Scand 2006; 50: 222–7. 5. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with Bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology 2008; 109:502-11. 6. Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr Drug Targets 2009; 10: 696-706. 7. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anaesth Analg 2010; 111:1548-51. 8. Sarita S Swami, Varshali M Keniya, Sushma D Ladi, Ruchika Rao. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study.IJA Year 2012: 56: 3 :243-249 9. Preeti More, Basavaraja , Vandana Laheri. A comparison of dexmedetomidine and clonidine as an adjuvant to local anaesthesia in supraclavicular brachial plexus block for upper limb surgeries 10. Jeby Mathew, Dr. R. Gowthaman and Dr. Dhakshinamoorthy. Comparison of dexmedetomidine and clonidine as an adjuvant to local anaesthesia in supraclavicular block. International Journal of Modern Research and Reviews 2014; 2: 463-465 11. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth 2011; 55:116-21. 12. Archana Tripathi, Khushboo Sharma, Mukesh Somvanshi, Rajib Lochan Samal. A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block. Journal of anaesthesiology clinical pharmacology. Year: 2016:32:3: 344-348 13. Fayaz Ahmad Munshi, Fahmeeda Bano, Aftab Ahmad Khan, Basharat Saleem, Mushtaq Ahmad rather. comparison of dexmedetomidine and clonidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block: a randomised double blind prospective study.JEMDS . 2015: 4: 42: 7263-7268 14. Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potential in frog sciatic nerve without α2 adrenoceptor activation. Br J Pharmacol 2010; 160:1662-76. Table 1: Demographic variables and duration of surgery Group BC Group BD p value Age 36.8±12.26 34.88±9.03 0.12 Weight 65.7±10.15 64.5±8.27 0.65