A Prospective Study on Upper Limb Supraclavicular Brachial Plexus Block: Dexmedetomidine with Ropivacaine and Dexamethasone with Ropivacaine and Ropivacaine Alone
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 1772-1782
Pain is defined as “As unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain is an inevitable consequence of surgery. Surgical intervention done to reduce human suffering is associated with pain and distress to patients. Severe pain causes increased stress response to surgery, seen as a cascade of endocrine, metabolic and inflammatory events that may contribute to organ dysfunction, morbidity, increased hospital stay and mortality.
Material and Methods:
The present study from May 2020 to March 2022 was conducted on 60 cases prospectively in patients admitted to the, Department of anaesthesia ,Dr. N.D. Desai FMSR, Dharmasinh Desai University, College Road, Nadiad, Gujrat, undergoing elective upper limb surgery. The inclusion and exclusion criteria, 60 ASA physical status I or II patients of either sex, aged 18-60 yrs were randomly allocated in to 3 groups of 20 each.
Group I: Patients receiving 0.5% Ropivacaine (30ml) + Dexmedetomidine 50mcg (diluted to 2 ml).
Group II: Patients receiving 0.5% Ropivacaine (30ml) + Dexamethasone 8mg (2ml).
Group III: Patients receiving 0.5% Ropivacaine (30ml) + saline (2ml).
Under strict aseptic precautions, patients were given Ultrasound guided Supraclavicular brachial plexus block with any one of the study drugs .
Demographic data(age ,sex distribution ,weight) and surgical characteristics (duration of surgery and type of surgery) were similar in all the 3 groups.
ONSET OF SENSORY AND MOTOR BLOCKADE : The mean time for onset of sensory block in group I was 7.45±1.10 min and in group II was 10.15 ± 1.14 min and group III was 12.45±2.76 . The mean time for onset of motor block in group I was 10.60 ± 1.05 min and in group II was 14.95 ± 0.83 min and and group III was 16.05 ± 1.96.
The onset of sensory and motor block was significantly early in Dexmedetomidine group (group I) i.e, 7.45±1.10 min followed by dexamethasone group (group II) as compared to plain Ropivacaine group (group III).
DURATION OF SENSORY AND MOTOR BLOCKADE: The total duration of sensory block in group I was 768±25.52 min and in group II was 909±22.10 min and in group III was 450±27.74 min. The duration of motor block in group I is 717.50±22.09 min and in group II was 878±19.47 min and in group III was 420±23.17 min.
There is significant difference in the total duration of sensory and motor block between the three groups. (P <0.001).The duration sensory and motor blockade is longest in Dexamethasone group followed by Dexmedetomidine group as compared to the control group Ropivacaine alone.
We conclude that although both Dexmedetomidine and Dexamethasone are better adjuvants to Ropivacaine as compared to Ropivacaine alone in Supraclavicular Brachial block , Dexamethasone is a better choice in terms of prolonging the duration of sensory and motor blockade and duration of analgesia, followed by Dexmedetomidine than Ropivacaine alone.
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