Akanksha Aggarwal

Abstract

Introduction:  Supraclavicular brachial plexus block is among foremost technique of regional anaesthesia administered during upper-limb surgery. Different adjuvants have been used with varied results for prolonging the sensory and motor blockade. Dexamethasone and Clonidine have been established as suitable adjuvants for blocks. Adding adjuvants to local anaesthetic drugs in nerve blocks has many benefits. We studied performance of dexamethasone or clonidine as additives to local anaesthetic in subclavian perivascular block as a part of upper limb surgery. Aim was to ascertain which of them is a better adjuvant. Materials and Methods: Study population was randomized to 2 groups of 50 patients each. Group 1 was given 5 ml of 2% lignocaine and 15 ml 0.5% bupivacaine with 8mg dexamethasone. Group 2 received 5ml 2% lignocaine and 15 ml 0.5% bupivacaine with 0.150 mg clonidine. Time to establishment of sensory & motor block, duration of analgesia and any adverse effects were observed. Statistical analysis was done with SPSS 13.0. Quantitative variables were assessed using student t test. Qualitative variables were analysed using Chi square test. P value < 0> Results:  Onset of sensory blockade was at 7.23+4.24 in group 1 and 8.36+2.68 minutes in Group 2. Average time to motor block was at 8.48+3.22 minutes in Group 1 and 9.58+3.71 minutes in Group 2. Analgesia’s duration in Group 1 and Group 2 was 998.2+338.5 and 879.3+284.5 minutes respectively. No major adverse events were seen in either group. Conclusion:  Performance of dexamethasone was similar to clonidine as adjunct to local anaesthetic in subclavian perivascular approach of brachial plexus block. However, it has faster sensory and motor blockade’s onset. Analgesia’s duration observed was found to be longer, though the difference was statistically insignificant.   Keywords: Upper limb surgery, Supraclavicular brachial plexus block, Clonidine, Dexamethasone.

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Abstract

Background: Dilatation and curettage (D and C) is an essential and common minor surgery in obstetrics and gynecology. Sedation, hypnosis and analgesia are used in combination for such short procedures. These days conscious sedation is provided to patients for day care surgeries which includes analgesia, sedation and anxiolysis while rapid recovery is ensured without side effects. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and conscious sedation without respiratory depression. Objective: It was to study the effect of dexemedetomidine with fentanyl versus Pentazocine with promethazine on hemodynamic stability and recovery during sedation in dilatation and curettage procedure. The comparison included the hemodynamic data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Materials and Methods: In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedetomidine loading dose 1 ?g/kg over 10 min and followed by 0.5 ?g/kg/hr infusion till completion of surgery and group PP received pentazocine 0.5 mg/kg (max 30mg) and Promethazine 12.5 mg slow intravenous Bolus. Results: Dexmedetomidine is a safe drug which provides good hemodynamics and less recovery time. It also exerts sedative and analgesic effects without respiratory depression unlike most analgesic/sedative drugs, such as ketamine, pentazocine and benzodiazepines. Conclusion: This study demonstrates that dexmedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine administration showed better preservation of MAP and SpO2. Keywords: Dexmedetomidine, Pentazocine, Fentanyl, Promethazine.

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