Efficacy of Dexamethasone and Clonidine as an Adjuvant in Supraclavicular Brachial Plexus Block

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Efficacy of Dexamethasone and Clonidine as an Adjuvant in Supraclavicular Brachial Plexus Block

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Background and Objectives: Dexamethasone, a synthetic corticosteroid has been found to prolong local anesthetic block duration. Clonidine, an Alpha-2-receptor agonist, has been used as an additive to local anesthetics for various regional anesthetic techniques. We compared Dexamethasone and Clonidine as an adjuvant to local anesthetic agent in supraclavicular brachial plexus block with respect to onset of sensory and motor block and duration of post-operative analgesia. Methodology: A prospective, randomized, controlled, double blind study carried out at Bangalore Medical College and Research Institute, Bengaluru. ASA I and II patients aged 18 to 60 years of either sex were included in the study. We compared the anesthetic and analgesic effects of adding dexamethasone and clonidine to 30 ml 0.5% Bupivacaine and injecting into brachial plexus sheath in 60 patients undergoing upper extremity surgeries. Patients were randomized into 2 groups of 30 each. Group D received Dexamethasone 8 mg and Group C received clonidine 75 mcg as an adjuvant to 0.5% bupivacaine. Results: There was a significant difference in onset of sensory and motor blockade and postoperative analgesia between two groups. Mean onset of sensory block and motor block was 5.9±0.8 minutes and 8.4±0.9 minutes in dexamethasone group and 8.7±0.9 minutes and 11.7±1.5 minutes in clonidine group. Mean duration of postoperative analgesia was 7.3±0.7 hours in dexamethasone group and 5.9±0.5 hours in clonidine group. There was significant difference in mean HR, SBP and DBP between two groups from 0 min to 12 hours. Mean heart rate, SBP and DBP was higher in dexamethasone group at all intervals compared to clonidine group. Conclusion: Our study demonstrates that, dexamethasone provides faster onset of sensory block and motor block, longer duration of post-operative analgesia, less number of rescue analgesics in post-operative 12 hours with cost-effectiveness. Hence, dexamethasone can be an alternative to clonidine in brachia plexus block.

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