A Comparative Study of the Efficacy of Dexmedetomidine and Clonidine as an Adjuvant to Bupivacaine

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A Comparative Study of the Efficacy of Dexmedetomidine and Clonidine as an Adjuvant to Bupivacaine

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Background: Supraclavicular brachial plexus block is preferable to general anesthesia in upper limb surgeries. Various adjuvants have been added to improve the quality of the block and prolong postoperative analgesia. Alpha-2 agonists are used as adjuants to local anesthetics to extend the duration of neuraxial and peripheral nerve blocks. We compared clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Aims: To compare the effects of Clonidine and Dexmedetomidine when added as adjuvant to Bupivacaine on onset and duration of sensory & motor block, duration of analgesia and quality of block for Supraclavicular brachial plexus block. Methods: In this prospective, double-blinded study 60 ASA I–II patients were randomly divided into two groups of 30 each. First group received 30 ml bupivacaine 0.325% with Clonidine 1 mcg/kg (Group C) and second group received 30 ml bupivacaine 0.325% with dexmedetomidine 1 mcg/kg (Group D) in Supraclavicular brachial plexus. The characteristics for anesthesia and analgesia were assessed for the two groups. Results: Onset of sensory block was faster in Group D than in Group C, while onset of motor block was faster in Group C than in Group D, but the difference was not statistically significant. Duration of sensory block and motor block was 234.17 ± 24.11 min and 296.30 ± 25.78 min in Group C as compared with 445.07 ± 67.79 min and 503.10 ± 75.67 min in Group D. Statistically significant longer duration of sensory and motor block was observed in Group D (p < 0.001). There was significant increase in duration of analgesia in Group D (477.27 ± 70.11 min) as compared with Group C (285.43 ± 26.88 min). In Group D, 83.3% of the patients achieved Grade IV quality of block as opposed to 43.3% in Group C (p = 0.006). Conclusion: To conclude, dexmedetomidine prolongs the duration of sensory and motor block and enhances the quality of block as compared with clonidine when used as an adjuvant to Bupivacaine. The added advantage of conscious sedation, hemodynamic stability, and minimal side-effects makes it a potential adjuvant for nerve blocks.

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