Dexmedetomidine As An Adjuvant To Levobupivacaine In Ultrasound-Guided Supraclavicular Brachial Plexus Block For Upper-Limb Orthopaedic Surgery: A Prospective Randomized Double-Blind Study

Abstract

Background

Supraclavicular brachial plexus block (SCBPB) is a common regional anaesthesia technique used for upper limb surgeries. This block provides safe and effective anaesthesia with excellent post-operative analgesia.  Local anesthetics alone sometimes provide suboptimal analgesia and delayed onset time, prompting the investigation of adjuvants like Dexmedetomidine to enhance these parameters.

Objective This study aims to compare the efficacy of dexmedetomidine (1µg/kg) as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block with respect to the onset and duration of blockade, analgesia. Methods: A randomised controlled study was conducted on patients undergoing upper limb orthopaedic surgeries using ultrasound-guided SCBPB. Patients were divided into two groups: Group I received 19 mL of 0.5% levobupivacaine and 1 mL Normal Saline, and Group II received 19 mL of 0.5% levobupivacaine and 1 µg/kg dexmedetomidine diluted to 1 mL using Normal Saline.

The onset and duration of sensory and motor blockades, duration of analgesia, perioperative hemodynamic stability, and adverse effects were recorded and analysed.

Results

The addition of dexmedetomidine significantly shortened the onset of sensory block (6.03 ± 1.10 vs. 9.60 ± 1.25 minutes; p < 0.001) and motor block (12.43 ± 1.72 vs. 16.23 ± 1.70 minutes; p < 0.001). Recovery of sensory and motor blockade was prolonged by approximately 184 and 160 minutes, respectively, and postoperative analgesia was significantly extended (800.33 +79.48 vs 1076.17 +78.02 minutes; p< 0.001) without increasing adverse events or causing clinically significant hemodynamic instability.

Conclusion:

 Perineural dexmedetomidine significantly improves the quality of ultrasound-guided supraclavicular brachial plexus block by accelerating block onset, prolonging sensory and motor blockade, and extending postoperative analgesia while maintaining acceptable hemodynamic stability.