Comparative Study Between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in Supraclavicular Brachial Plexus Block

Abstract

Basim Herez Ali, Mohamed Fadhil Hussain, Raad Jasim Isa

Background The supraclavicular brachial plexus block exhibits a good anesthetic and analgesic effect to the upper extremity below the shoulder (mid and lower shaft of humerus, elbow, forearm, hand and fingers) and reduces the need for opioid consumption. Among many medications, dexamethasone and dexmedetomidine had been used as effective adjuvants to the local anesthetics in brachial plexus block.
Aim: To compare the block characteristics with dexamethasone versus dexmedetomidine as adjuvant to bupivacaine hydrochloride in SCBPB.
Patient and methods: 75 patients’ average weight were allocated and divided into three equal groups. Combined ultrasound and nerve stimulation – guided SCBPB had been done. Control group received 0.5% bupivacaine alone. Dexmedetomidine group, received 0.5% bupivacaine with dexmedetomidine. In dexamethasone group, patient received 0.5% BPV plus dexamethasone. The sensory block was tested by Hollmen scale, while Motor block was monitored by a modified Bromage Scale, Pain was monitored and evaluated by using the visual analogue score.
Results: A prolonged effect of both sensory and motor block were observed in both dexamethasone group and dexmedtomidine group(more significant in D) than group C. Total dose of analgesic (tramadol in mgs in 24 hours) was obviously reduced in dexamethasone and dexmedetomidine groups than group C.
Conclusion
Dexmedetomidine and dexamethasone both are good adjuvants in peripheral nerve blocks, but Dexamethasone had better effects on sensory and motor block duration in comparison with dexmedetomidine. Time of first analgesic request in dexamethasone group was longer than dexmedetomidine group.