Observational Study of 0.25% Levobupivacaine with Dexmedetomidine 1mcg/Kg Versus 0.375% Ropivacaine with Dexmedetomidine 1mcg/Kg in Usg Guided Infra Clavicular Brachial Plexus Block Administered to Patients Undergoing Upper Limb Surgeries.

Abstract

Background:Pain is defined as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”. There are various minimally invasive anesthetic techniques available today to deal with pain. Peripheral nerve block is one of them which entails injecting local anesthetic around the nerve or plexus to make particular dermatomes resistant to pain and noxious stimuli. The brachial plexus blocks are an excellent technique for anaesthesia while performing surgeries of the upper limb. The infraclavicular block was designed by neurologists to overcome the deficiencies of the axillary block. Compared to landmark techniques, the use of ultrasound guidance improves safety. The present study compared the onset and duration of sensory and motor blocks, duration of postoperative analgesia, and hemodynamics of 0.25% levobupivacaine with 1 mcg/kg dexmedetomidine versus 0.375% ropivacaine with 1 mcg/kg dexmedetomidine in infraclavicular brachial plexus blocks. 

Materials and methods: AProspective randomized double blinded observational study was conducted on sixty-two ASA physical status I and II patients, aged between18–60 years undergoing upper limb surgeries under Infraclavicular brachial plexus block.These patients were randomly allocated into either one of the two groups (Group LD and Group RD) by the computer-generated randomized numbers. Group LD was given 30 ml of 0.25% Levobupivacaine with 1mcg/kg Dexmedetomidine and Group RD was given 30 ml of 0.375% Ropivacaine with 1mcg/kg Dexmedetomidine. Both the groups were compared with respect to theonset and duration of sensory and motor block, duration of analgesia, hemodynamic parametersand complications if any.

Results: The outcomes were analysed using statistical software SPSS version 22.0, Repeated Measures Anova is applied to find the relationship between two groups. It was observed that the onset of sensory (p value 0.04) and motor blockade (p value 0.01) was faster, duration of action and was longer (p value 0.0001), and the time required for rescue analgesia was longer (p value 0.0001) with minimal hemodynamic complications(p value 0.08) in Levobupivacaine group compared to Ropivacaine group.

Conclusion: Based on this study results, it has been concluded thatboth the local anaesthetics Ropivacaine and Levobupivacaine when combined with Dexmedetomidine as an adjuvant, prolonged the block duration and decrease the need for rescue analgesia. After comparing various parameters, 0.25% levobupivacaine with 1mcg/kg Dexmedetomidine is preferred to 0.375% Ropivacaine with 1mcg/kg Dexmedetomidine for postoperative pain management due to its pharmacological properties.