EFFECT OF ADDITION OF DEXMEDETOMIDINE TO ROPIVACAINE HYDROCHLORIDE (0.75%) IN BRACHIAL PLEXUS BLOCK THROUGH SUPRACLAVICULAR ROUTE IN UPPER LIMB SURGERIES: A CLINICAL COMPARATIVE STUDY

CORRESPONDING AUTHOR:
Dr. Neelesh Nema,
Room No. 24,
Medical P. G. Boys Hostel,
MGM Medical College,
Residency Area, Indore.
Email: neeleshnema@yahoo.com

ABSTRACT: Brachial plexus block is a popular and widely employed regional nerve block of upper extremity which avoids the unwanted effect of anesthetic drugs used during general anesthesia, there complication and the stress of laryngoscopy and tracheal intubation. Patients also have a post-operative period free from nausea, vomiting, cerebral depression and immediate post-operative pain.

The brachial plexus via supraclavicular approach block provide safe, effective, low cost complete anesthesia or analgesia of the upper extremity and is carried out at the level of the distal trunks/divisions of the brachial plexus, where it is in its tightest formation thus allowing for rapid and completed anesthesia or analgesia of the upper limb. The present single centre, prospective, randomized, double blind study was undertaken to compare the effects of Ropivacaine and Ropivacaine-Dexmedetomidine combination in brachial plexus block via supraclavicular route with respect to its onset, duration of action. A total of 60 patients of ASA grading I &II and age ranging 18-50 year of either sex underwent various elective upper limb surgeries were divided in two equal groups Group A (n=30): Received brachial plexus block with 30 ml Ropivacaine (0.75%.) Group B (n=30): Received brachial plexus block with 29 ml Ropivacaine (0.75%) + 1 ml Dexmedetomidine (50µg.) After performing supraclavicular block the following observations were made: 1. Onset of sensory blockade. 2. Duration of sensory blockade. 3. Onset of motor blockade. 4. Duration of motor blockade. 5. Duration of analgesia. The onset and duration of sensory blockade was assessed by pin prick response on area of all four nerves of upper limbs. The onset and duration of motor blockade was assessed by Modified Bromage Scale. The onset and duration of analgesia was assessed by response to pin prick and time of first request of analgesic dose. The observations were as follow: - The average time of onset of sensory blockade was 14.20 ±5.229 mins in-group A and 7.20±2.483 mins in-group B. The observed average onset of motor blockade was 21.00±8.566 mins in group A and 11.83±3.824 mins in group B. The average duration of sensory blockade was 310.37±66.359 mins in group A and 435.87±102.309 mins in group B respectively. The average duration of motor blockade was 278.50 ±66.887 mins in group A and 390.47 ±107.868 mins in group B. The average duration of analgesia was 378.53±80.93 min and 970.83±237.623 mins in groups A and B respectively. There was statistical significant difference in terms of onset & duration of sensory, motor blockade and duration of analgesia between the two groups.

KEYWORDS: Brachial plexus block, Ropivacaine, Dexmedetomidine, Visual analogue score, and Modified Bromage scale.