Aman Malawat

Abstract

Background and Aim: Subarachnoid block is the most common technique employed for lower limb surgeries. When used as an adjuvant to intrathecal local anaesthetic, both fentanyl and dexmedetomidine have the ability increase perioperative analgesia. This study aimed to compare and evaluate the effective profile of dexmedetomidine and fentanyl as an adjuvant to intrathecal bupivacaine in lower limb surgeries. Materials and Methods: In this clinical trial, 90 patients undergoing elective lower limb surgeries under spinal anaesthesia were randomly allocated to two groups. In group BD, the patients received 0.5% hyperbaric bupivacaine 12.5 mg + dexmedetomidine 5 mcg. In group BF, the patients received 0.5% hyperbaric bupivacaine 12.5 mg + fentanyl 25 mcg. Onset, duration, regression of sensory and motor blockade along with haemodynamic variations and side effects were compared between both the groups. Results: The onset of sensory block was earlier in Group BD, while the onset of motor block was earlier in Group BF. However, the differences with the onset of sensory and motor block remained statistically insignificant (P = 0.4988 and 0.4918). The mean time for two-segment sensory regression, time for regression to L1 dermatome and duration of motor block was significantly less in Group BF. The analgesic requirement in the early postoperative period and the haemodynamic variation remained statistically insignificant in both the groups. Conclusion: Intrathecal dexmedetomidine provided prolonged sensory as well as motor blockade thereby enhancing postoperative analgesia. Keywords: Adjuvants, Bupivacaine, Fentanyl, Dexmedetomidine.

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Abstract

Introduction and Aim: Supraclavicular brachial plexus block is the most suitable mode of anaesthesia for various upper limb surgeries. Dexmedetomidine added to local anaesthetics shortens the onset time and prolongs the duration of block and post-operative analgesia in the brachial plexus block. However, there remains limited knowledge of its analgesic efficacy and duration in peripheral nerve and nerve plexus blockade. Materials and Methods: This prospective randomized double-blinded study was conducted with 60 patients of ASA physical status class I/II, scheduled for elective unilateral upper limb surgery. Patients were randomized into 2 groups of 30 each. All patients in Group L received a brachial plexus block with 29 ml of 0.5% levobupivacaine + 1ml of normal saline. Group LD received 29 ml of 0.5% levobupivacaine + 1ml of dexmedetomidine 1ml(100mcg). The primary objectives were the onset and duration of sensory and motor block. Results: The onset of sensory and motor block was earlier in Group L (12.4 3.1 min and 20.5 3.8 min) than Group LD (15.9 2.7 min and 22.1 3.2 min), (P = 0.0000 and 0.0801). The duration of sensory and motor block was longer in Group LD (1198.0 48.5 min and 1178.3 41.4 min) than Group L (710.3 87.3 min and 688.7 86.6 min), (P =0.0000). The duration of analgesia was longer in Group LD (1222.0 49.2 min) than Group L (726.3 91.1 min), (P < 0> Conclusion: Dexmedetomidine added with levobupivacaine prolongs the duration of sensory as well as motor block in brachial plexus block using the supraclavicular technique with haemodynamic stability. Keywords: Brachial plexus block, Dexmedetomidine, Levobupivacaine, Supraclavicular.

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