Using 0.5% Ropivacaine Alone in Upper Arm Surgeries: An Observational Study

What is it about?

Using 0.5% Ropivacaine Alone in Upper Arm Surgeries: An Observational Study

Featured Image

Photo by Judy Beth Morris on Unsplash

Photo by Judy Beth Morris on Unsplash

Why is it important?

Background: Interscalene brachial plexuses block is one of the delicately done widely used blocks for upper humerus and shoulder surgeries. Ropivacaine, a newer Local Anaesthetic (LA), has been increasingly used nowadays in different concentrations for peripheral nerve blocks including brachial plexux block. Dexmedetomidine, a selective α2-receptor agonist has also been reported to improve the quality of intrathecal and epidural anesthesia when used along with LA as adjuvant. In this background, this study was undertaken to observe any alteration of the quality of brachial plexus block when dexmedetomidine used as an adjuvant along with ropivacaine in interscalene approach while performing upper arm surgeries. Methods: On obtaining Institutional Ethics Committee approval, sixty patients in total were studied when equally divided into two groups, R and RD. Thirty Patients for each group (either R or RD) were studied who fulfilled inclusion protocol and underwent surgery under brachial plexus block. Patients observed in group R received 30 ml of 0.5% ropivacaine and patients observed in group RD received 30 ml of 0.5% ropivacaine with 50 μg (0.5 ml) dexmedetomidine by electrical stimulations by using peripheral nerve stimulator (PNS) for brachial plexus block. All patients were primarily assessed for 24 hours for duration postoperative pain relief using VAS pain score (0-10centimeter). Secondarily onset and duration of sensory and motor blocks were assessed as well. Patient satisfaction scores (PSS) were also recorded by a specific scoring method for 24 h postoperatively where score 5=excellent, 4=very good, 3=good, 2=fair, and 1=poor. All patients were also monitored for hemodynamic parameters, oxygen saturation, respiratory parameters, sedation and any other adverse outcome for 24 hours. Results: The independent samples t test and Chi square test procedures were used to compare means and standard deviations for two groups of cases accordingly. Parametric and nonparametric data were assessed accordingly and p value < 0.05 was considered as significant. Patients observed in both groups were comparable with respect to baseline demographic characteristics. Total duration of analgesia in patients of group R was 540.21 ± 11.54 minutes and in group RD was 630.75 ± 10.67 min. The difference was statistically significant (p value <0.0001). Onset and duration of sensory and motor blockade were also found to be shortened and prolonged respectively in patients of group RD in comparison to group R. PSS were also found to be better in group RD. Conclusion: Dexmedetomidine when added in a relatively low dose as an adjuvant to bupivacaine for interscalene brachial plexus block, it was observed to shorten the onset time and prolongs the duration of both sensory and motor blocks with significant prolongation of duration of postoperative analgesia in patients undergoing upper humerus and shoulder surgery.

Perspectives