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A PROSPECTIVE RANDOMISED DOUBLE BLINDED STUDY TO EVALUATE THE EFFICACY OF DEXMEDETOMIDINE (50 μg) INTRAVENOUSLY AND PERINEURALLY AS AN ADJUNCT TO ROPIVACAINE 0.5% FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN ELECTIVE UPPER LIMB SURGERIES.

Dr SHASHIKALA T.K, Dr KAVYA MADHYASTHA.

Abstract
ABSTRACT
BACKGROUND: Dexmedetomidine, highly selective α2 agonist is used as an effective adjuvant to various local anaesthetics in regional anaesthesia. We have conducted this study to know the efficacy of Dexmedetomidine through two routes i.e intravenous and perineural routes with Ropivacaine for supraclavicular brachial plexus block in elective forearm surgeries.
METHODS: After the institutional ethical committee clearance, 60 patients aged between 18 to 60 years, belonging to ASA class I and II were randomly divided into two groups of 30 each after a detailed informed consent. Group DPN received 0.5% Ropivacaine 28ml + 2ml of dexmedetomidine 50μg perineurally and 100 ml of 0.9% normal saline intravenously. Group DIV received 0.5% Ropivacaine 28ml + 2ml 0.9% normal saline perineurally and 50μg of Dexmedetomidine in 100ml of 0.9% normal saline intravenously. Primary objectives were to know the time of sensory onset, motor onset, time for complete motor and sensory block, the total duration of sensory and motor block and total duration of analgesia. Secondary objectives were haemodynamic parameters, sedation scores and adverse events. Statistical methods were carried out through the SPSS for Windows (version 16.0)
RESULTS: The demographic profile of the patients like age, sex, height, weight, BMI were similar in both groups. The sensory and motor onset time as well as time for complete sensory and motor block was earlier in Group DPN than Group DIV. The sensory block duration was prolonged in Group DPN (686.33 52.22 min) compared to Group DIV (371 38.98 min) [P value < 0.001]. the motor block duration was also significantly prolonged in Group DPN ( 593.50 58.12 min) compared to Group DIV (319.50 26.47 min) [P value < 0.001]. The total duration of analgesia was also significantly prolonged in Group DPN (701.83 44.92 min) compared to Group DIV ( 405.16 30.86 min)[P value < 0.001]. Two patients had bradycardia and one patient had hypotension in Group DIV. Ramsay sedation scores in both the groups were < 3.
CONCLUSION: Dexmedetomidine is an excellent adjuvant to Ropivacaine for the supraclavicular block. Perineural Dexmedetomidine offers a better block quality and a prolonged duration of analgesia compared to intravenous Dexmedetomidine with minimal side effects

Key words: Dexmedetomidine, Ropivacaine, brachial plexus block



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