A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT WITH LEVOBUPIVACAINE FOR SUPRACLAVICULAR ULTRASOUND GUIDED BLOCK IN TERTIARY CARE HOSPITAL
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Keywords
Supraclavicular block, Dexamethasone, Dexmedetomidine, USG, Levobupivacaine.
Abstract
The search for newer and safer anaesthetic agents has always been a key priority in anaesthesiology. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, has emerged as a safer option for regional anaesthesia compared to its racemic counterpart. Additionally, various adjuvants have been used alongside local anaesthetics to shorten the onset time and extend the duration of analgesia in brachial plexus blocks. However, there is limited research on the use of Dexmedetomidine and Dexamethasone as adjuvants with Levobupivacaine.
Aims: The primary aim of the study is to know the effect of Dexmedetomidine and Dexamethasone as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block.
Methods: A descriptive, observational study was conducted on 60 ASA Grade I and II patients undergoing upper limb surgeries under supraclavicular brachial plexus block using an ultrasound machine. The patients were randomized into two groups of 30 each to receive either Dexmedetomidine 20 ug [group M] or Dexamethasone 4mg [group A] as an adjuvant to Levobupivacaine. The effect of Dexmedetomidine and Dexamethasone as an adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block with regards to onset and duration of motor and sensory block, duration of analgesia, need for rescue analgesia and number of rescue analgesia in first 8 hours after surgery was evaluated.
Results: The mean onset time for sensory block in our study group M was 5.10 ± 1.16 minutes
The mean duration of sensory block in our study group M was 12.70 ± 0.84 hours
The mean onset time for sensory block in our study group A was 2.20 ± 0.89 minutes
The mean duration of sensory block in our study group A was 14.17 ± 1.02 hours
The mean onset time for motor block in our study group M was 6.97 ± 1.10 minutes
The mean duration of motor block in our study group M was 11.63 ± 0.81 hours
The mean onset time for motor block in our study group A was 3.17 ± 1.14 minutes
The mean duration of motor block in our study group A was 13.10 ± 0.99 hours
The mean duration of analgesia in our study group M was 13.43 ± 0.73 hours
The mean duration of analgesia in our study group A was 15.00 ± 0.74 hours
Conclusion: Dexmedetomidine and Dexamethasone can be effectively and safely used as an adjuvant to Levobupivacaine (0.5%) in USG guided Supraclavicular block in patients undergoing forearm orthopaedic surgeries. There was no statistical difference in the onset of sensory and motor blockade However, due to paucity of studies in literature, there is still scope for further study using different drug dosage strengths.
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Dr Sukriti Atram
Associate Professor, Department of Anaesthesia and critical care, Grant Government Medical College, Mumbai
Dr Poonam Vasantrao Nakaskar
Senior Resident, Department of Anaesthesia, GMC, Akola
Dr Mayur Masurkar
Senior Resident, Department of Anaesthesia, Trauma care centre, Jogeshwari, Mumbai
