A clinical study comparing clonidine with dexmedetomidine as adjuvants to local anaesthetic agent in brachial plexus block via inter-scalene approach for early discharge

Abstract

It is a known fact that use of peripheral nerve block with local anaesthetics like lignocaine and bupivacaine for anaesthesia reduces both operating room time and length of hospital stay and provide good postoperative analgesia. Various additives can be added to local anaesthetics to accelerate the onset time, to reduce the systemic absorption (thus the risk of local anaesthetic related toxicity) and prolong the duration of nerve block/pain relief. Yet the quest continued for better drug which meets the above criteria and even then keeping the patient awake and alert to make him fit for early ambulation and discharge. 60 patients aged 18 - 65 years with ASA grade I were randomly divided into group I and group II to receive 10 ml of lignocaine 2% and 20 ml of bupivacaine 0.5% with 90µg of clonidine or dexmedetomidine 25µg respectively. Onset of sensory blockade was determined by pinprick method by three point score and motor blockade by three point scale. Duration of postoperative analgesia, the hemodynamic changes, sedation scores, any adverse effects and recovery criteria were observed. Statistical analysis was done by student’s “t” test and p < 0.05 was considered significant. It was found that there was faster onset of sensory and motor blockade, the postoperative analgesia was prolonged and the amount of sedation was profound in group II as compared to group I. All the above findings were statistically significant. Many of the patients in group II were found to be alert and fit for discharge on 2nd day as compared to group I, Therefore, it was recommended that Dexmedetomidine 25µg is a better option as an additive than clonidine 90µg for hastening the onset of sensory and motor block with prolonged postoperative analgesia, sedation  and alert &awake patient ready for discharge on the 2nd day.

KEY WORDS: Inter-Scalene Brachial Plexus Block, Clonidine, Dexmedetomidine