COMPARISON OF FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED-DOUBLE BLIND PROSPECTIVE STUDY
Objectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to local
anesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We compared
the sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicular
brachial plexus block.
Methods: A total of 50 American Society of Anesthesiologist's Physical Status I and II patients scheduled for elective upper limb surgeries under
supraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 ml
bupivacaine with fentanyl 50 Î¼g and Group BD received 30 ml bupivacaine with dexmedetomidine 50 Î¼g. The characteristics for anesthesia and
analgesia were assessed in both groups.
Results: Duration of sensory and motor block was 363.4Â±38.36 minutes and 357Â±36.77 minutes, respectively, in Group BF while it was
452.96Â±77.12 minutes and 441.52Â±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motor
block between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF
(471.44Â±65.88 minutes vs. 366.48Â±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any group
except for Grade 3 sedation score which was more in Group BD.
Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motor block and also the duration of analgesia, more than when fentanyl was added to bupivacaine.
Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.
Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuvant for brachial plexus block: A systemic review. Anesth Analg 2000;90(5):1122-8.
Madhusudan R, Kumar K, Kumar R, Potli S, Karthik D, Kapil M. Supraclavicular brachial plexus block with 0.75% ropivacaine and with additives tramadol, fentanyl â€“ A comparative pilot study. Int J Biol Med Res 2011;2(4):1061-3.
Nishikawa K, Kanaya N, Nakayama M, Igarashi M, Tsunoda K, Namiki A. Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Anesth Analg 2000;91(2):384-7.
Ammar AS, Mahmoud KM. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi J Anaesth 2012;6(2):109-14.
Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (a2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study. Indian J Anaesth 2012;56(3):243-9.
Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50(2):222-7.
Memis D, Turan A, Karamanlioglu B, PamukÃ§u Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004;98(3):835-40.
Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010;111(6):1548-51.
Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol 2010;27(3):280-4.
Ramsay MA, Savage TM, Simpson BR, Godwin R. Controlled sedation with alphaxolone-alphadolone. Br Med J 1974;2(5920):656-9.
Kardas K, Schools A, Concepcion M. Effect of brachial plexus fentanyl on supraclavicular block. A randomized, double-blind study. Reg Anaesth 1996;20(4):311-5.
Karakaya D, Buyukgoz F, Baris S, Guldogus F, Tur A. Addition of fentanyl to bupivacaine prolongs anaesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med 2001;26(5):434-8.
Geze S, Ulusoy H, ErtÃ¼rk E, Cekic B, Arduc C. Comparison of local anaesthetic mixtures of tramadol or fentanyl for axillary plexus block in orthopaedic upper limb surgery. Eur J Gen Med 2012;9(2):118-23.
Sindjelic RP, Vlajkovic GP, Davidovic LB, Markovic DZ, Markovic MD. The addition of fentanyl to local anaesthetics affects the quality and duration cervical plexus block: A randomized controlled
AQ2trial. Anaesth Analg 2010;111(1):234-7.
Chavan SG, Koshire AR, Panbude P. Effect of addition of fentanyl to local anesthetic in brachial plexus block on duration of analgesia. Anesth Essays Res 2011;5(1):39-42.
El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anaesth 2000;47(10):962-7.
Cucchiaro G, Ganesh A. The effects of clonidine on postoperative analgesia after peripheral nerve blockade in children. Anesth Analg 2007;104(3):532-7.
Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia 1999;54(2):146-65.
Kaygusuz K, Kol IO, Duger C, Gursoy S, Ozturk H, Kayacan U, et al. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block. Curr Ther Res Clin Exp 2012;73(3):103-11.
Das A, Majumdar S, Halder S, Chattopadhyay S, Pal S, Kundu R, et al. Effect of dexmedetomidine as adjuvant in ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded and randomized controlled study. Saudi J Anaesth 2014;8 Suppl 1:S72-7.
Zhang Y, Chang-Song W, Jing-Hui S, Sun B, Shu-Jie L, Li P, et al. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block. Int J Clin Exp Med 2014;7(3):680-5.
Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg 2008;107(1):96-101.
Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: A volunteer study. Br J Anaesth 2013;110(3):438-42.
Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2014;30(1):36-40.
PÃ¶pping DM, Elia N, Marret E, Wenk M, TramÃ¨r MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology 2009;111(2):406-15.
Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potential in frog sciatic nerve without Î±2 adrenoceptor activation. Br J Pharmacol 2010;160(7):1662-76.
Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res 2012;2(1):67-9.
Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015;9(2):148-54.
Abdallah FW, Brull R. Facilitatory effect of perineural dexmedetomidine on neuraxial and peripheral nerve block. A systemic review and meta-analysis. Br J Anaesth 2013;110(6):915-25.
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