A PROSPECTIVE COMPARATIVE STUDY ON EFFECT OF FENTANYL AND DEXMEDETOMIDINE AS ADDITIVES TO ROPIVACAINE IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR ELECTIVE UPPER LIMB SURGERIES
Main Article Content
Keywords
Supraclavicular brachial plexus block; Dexmedetomidine; Fentanyl; Ropivacaine; Ultrasound guidance; Postoperative analgesia
Abstract
Background: Ultrasound-guided supraclavicular brachial plexus block (SCBPB) is a widely accepted regional anesthetic technique for upper limb surgeries. Ropivacaine is commonly used because of its favorable safety profile; however, its duration of analgesia may be limited when used alone. Adjuvants such as fentanyl and dexmedetomidine are therefore added to improve block characteristics and postoperative analgesia.
Objectives:To compare fentanyl and dexmedetomidine as additives to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block, postoperative analgesia, hemodynamic parameters, and adverse effects.
Methods: This prospective comparative study was conducted on 68 patients aged 18–60 years, classified as ASA physical status I or II, undergoing elective upper limb surgeries. Patients were randomized into two groups: Group F (n = 34) received 30 mL of 0.5% ropivacaine with fentanyl (1 µg/kg), and Group D (n = 34) received 30 mL of 0.5% ropivacaine with dexmedetomidine (1 µg/kg). The onset and duration of sensory and motor block, duration of postoperative analgesia, Visual Analogue Scale (VAS) scores, rescue analgesic requirement, intraoperative hemodynamic parameters, and adverse events were recorded and analyzed.
Results:The onset of sensory block was significantly faster in Group D compared to Group F (1.8 ± 0.3 vs 2.5 ± 0.7 minutes; p < 0.001), as was the onset of motor block (3.4 ± 0.8 vs 5.5 ± 1.1 minutes; p < 0.001). The duration of sensory block (785.3 ± 107.7 vs 674.1 ± 75.7 minutes), motor block (754.6 ± 117.1 vs 637.1 ± 84.8 minutes), and postoperative analgesia (1121.5 ± 190.6 vs 915.5 ± 164.1 minutes) was significantly longer in Group D (p < 0.001). Postoperative pain scores were consistently lower and the total rescue analgesic requirement was significantly reduced in the dexmedetomidine group (53.9 ± 22.8 mg vs 68.5 ± 26.8 mg; p < 0.001). Dexmedetomidine was associated with lower heart rate and blood pressure during the early intraoperative period, while oxygen saturation remained stable and comparable between both groups. The incidence of adverse effects was similar in the two groups.
Conclusion:Dexmedetomidine is a superior adjuvant to fentanyl when added to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block, providing faster onset, prolonged block duration, improved postoperative analgesia, and stable hemodynamic profile without an increase in adverse effects.
References
1. Mannion S. Regional anaesthesia for upper limb trauma: a review. AnesteziaRegionalǎpentruTraumatismeleMembrului Superior. 2013;20(1):49–59.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
1. Mannion S. Regional anaesthesia for upper limb trauma: a review. AnesteziaRegionalǎpentruTraumatismeleMembrului Superior. 2013;20(1):49–59.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
1. Mannion S. Regional anaesthesia for upper limb trauma: a review. AnesteziaRegionalǎpentruTraumatismeleMembrului Superior. 2013;20(1):49–59.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
1. Mannion S. Regional anaesthesia for upper limb trauma: a review. AnesteziaRegionalǎpentruTraumatismeleMembrului Superior. 2013;20(1):49–59.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
1. Mannion S. Regional anaesthesia for upper limb trauma: a review. AnesteziaRegionalǎpentruTraumatismeleMembrului Superior. 2013;20(1):49–59.
2. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):1–2.
3. Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. Acta Anaesthesiol Belg. 2012;63(1):15–21.
4. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am AcadOrthop Surg. 2012;20(1):38–47.
5. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42(2):233–40.
6. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015;9(2):148.
7. 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, randomized controlled study. Saudi J Anaesth. 2014;8(Suppl 1):S72.
8. Kaur M, Kaur R, Kaur S, Baghla N, Bansal A, Kalia A, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(3):669–75.
9. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–37.
10. Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine with ropivacaine in epidural anesthesia for lower limb orthopedic surgeries. Saudi J Anaesth. 2014;8(4):463–69.
11. Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27(12):3182–90.
12. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
13. Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. Evaluation of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–36.
14. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
15. Hamed MA, Talaat SM, Abdallah NM. Comparative study between fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Egypt J Anaesth. 2018;34(1):17–23.
16. Sahi S, Verma AK, Jindal P, Singh B, Bansal S. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Anesth Essays Res. 2018;12(2):420–425.
17. Cham SC, Sangawar MA, Ramtani UL, Chavan BS, Cham C. Comparison of the effects of fentanyl and dexmedetomidine in supraclavicular brachial plexus block achieved with ropivacaine. J Evol Med Dent Sci. 2015;4(54):9427–9437.
18. Dharmarao PS, Sindhura KS, Raghunath G, Praveen K. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Evid Based Med Healthc. 2018;5(38):2692–2697.
19. . Umamaheshwar L, Ramesh S, Kumar A. Comparison of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Indian J Clin Anaesth. 2022;9(1):45–50.
20. . Tyagi N, Jain A, Verma S. Comparative evaluation of dexmedetomidine and fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block. Cureus. 2023;15(3):e36421.
21. .Swaro S, Swaro B, Ramaswamy AH. Comparison of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. Int J Sci Stud. 2016;4(6):123–127.
22. . Farooq N, Singh RB, Sarkar A, Rasheed MA, Choubey S. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res. 2017;11(3):730–736.
23. Sahi S, Kaur M, Singh A. Dexmedetomidine versus fentanyl as adjuvants to local anesthetics in supraclavicular brachial plexus block: a comparative study. Int J Res Med Sci. 2018;6(5):1625–1630.
24. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Korean J Anesthesiol. 2016;69(1):68–73.
25. Yadav RK, Sah BP, Kumar P, Singh SN. A comparative study of fentanyl and dexmedetomidine as adjuvants to ropivacaine in supraclavicular brachial plexus block. J Clin Diagn Res. 2016;10(6):UC01–UC04.
26. Hashim NM, El-Shahawy MA, Abdallah NM. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams J Anaesthesiol. 2019;11:12.
27. . Patra P, Das S, Banerjee A. Dexmedetomidine versus fentanyl as adjuvants to ropivacaine in supraclavicular brachial plexus block: a randomized study. J Anaesthesiol Clin Pharmacol. 2022;38(2):215–221.
28. Lotfy ME, Doha NM, Elbakry AE, Mohamed SS. Comparative study between dexmedetomidine and fentanyl added to bupivacaine for ultrasound-guided brachial plexus block. Res OpinAnesth Intensive Care. 2020;7(1):25–31.
29. El-Raouf AM, Ahmed HM, Mohamed SA. Dexmedetomidine versus fentanyl as adjuvants in peripheral nerve blocks: a comparative study. Egypt J Hosp Med. 2020;78(1):154–160.
30. Ghasemi M, Pouraghaei M, Soleimanpour H. Comparison of fentanyl and dexmedetomidine as adjuvants to local anesthetics in regional anesthesia. Anesth Pain Med. 2021;11(2):e113412.
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Mar 03, 2026
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Dr. Mehak Shabir, Dr. Anjum Shamim, & Dr. Sabeeha Gul. (2026). A PROSPECTIVE COMPARATIVE STUDY ON EFFECT OF FENTANYL AND DEXMEDETOMIDINE AS ADDITIVES TO ROPIVACAINE IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR ELECTIVE UPPER LIMB SURGERIES. Journal of Population Therapeutics and Clinical Pharmacology, 33(2), 414-425. https://doi.org/10.69980/pj7rfg49
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Author Biographies
Dr. Mehak Shabir
Postgraduate Scholar, Department of Anaesthesiology and Critical Care, Government Medical College Anantnag.
Dr. Anjum Shamim
Associate Professor and Head, Department of Anesthesiology and Critical Care, Government Medical College Anantnag, India.
Dr. Sabeeha Gul
Assistant professor, Department of Radiology, Government Medical College Srinagar, India.
How to Cite
Dr. Mehak Shabir, Dr. Anjum Shamim, & Dr. Sabeeha Gul. (2026). A PROSPECTIVE COMPARATIVE STUDY ON EFFECT OF FENTANYL AND DEXMEDETOMIDINE AS ADDITIVES TO ROPIVACAINE IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR ELECTIVE UPPER LIMB SURGERIES. Journal of Population Therapeutics and Clinical Pharmacology, 33(2), 414-425. https://doi.org/10.69980/pj7rfg49
