Levobupivacaine and Dexmedetomidine versus Ropivacaine and Dexmedetomidine for Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Trial
Introduction: The Supraclavicular Brachial (SCB) plexus block is the preferred modality of anaesthesia for upper extremity surgeries. Technical and pharmacological advancements have made these blocks safer and more reliable. Ropivacaine and levobupivacaine are relatively newer drugs that are claimed...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-03-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/20801/75439_CE[Ra1]_F(SHU)_QC(PS_SS)_PF1(AG_OM)_PFA(IS)_PB(AG_IS)_PN(IS).pdf |
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| Summary: | Introduction: The Supraclavicular Brachial (SCB) plexus block is the preferred modality of anaesthesia for upper extremity surgeries. Technical and pharmacological advancements have made these blocks safer and more reliable. Ropivacaine and levobupivacaine are relatively newer drugs that are claimed to have better potency and less toxicity. Adjuvant drugs, like dexmedetomidine, are added to enhance the duration of the block and provide better postoperative analgesia.
Aim: To compare the effects of levobupivacaine (0.5%) with dexmedetomidine (50 μg) and ropivacaine (0.5%) with dexmedetomidine (50 μg) when used in the SCB plexus block for upper extremity surgeries.
Materials and Methods: A double-blinded randomised controlled trial was conducted from February 2024 to June 2024 at the Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India. Patients undergoing upper extremity surgeries under SCB block were randomised into two groups (LD: 0.5% levobupivacaine + 50 μg dexmedetomidine and RD: 0.5% ropivacaine + 50 μg dexmedetomidine). The onset, completion and duration of the block (both sensory and motor), haemodynamic parameters, time to rescue analgesia and adverse effects (sedation, pruritus, respiratory distress, bradycardia, hypotension) were compared between the two groups using Statistical Package for the Social Sciences (SPSS) software version 25.0. Categorical data were analysed using the χ² test and continuous variables were analysed using Analysis of Variance (ANOVA). A p-value <0.05 or less was considered statistically significant.
Results: Thirty-three patients were analysed at the end of the study. Both groups were matched for age and sex, with a mean age of participants of 36.6±14.66 years and a male-to-female ratio of 3.1. The groups did not significantly differ concerning haemodynamic parameters, except for the heart rate at 180, 210, and 240 minutes. The onset (LD: 10.44±4.774; RD: 11.82±5.457 minutes) and completion (LD: 21.38±7.473; RD: 25.59±6.256 minutes) of sensory and the onset (LD: 10.88±5.965; RD: 12.18±5.659 minutes) and completion (LD: 19.63±8.374; RD: 22.35±7.365 minutes) of motor block were comparable for both groups. However, the duration of sensory (LD: 859.38±186.650; RD: 716.12±163.620 minutes; p-value=0.025) and motor block (LD: 865.13±160.404; RD: 730.59±197.227 minutes; p-value=0.040) was significantly longer in the LD group, resulting in a delayed requirement for rescue analgesia (LD: 982.88±215.634; RD: 820.41±183.232 minutes; p-value=0.026).
Conclusion: Levobupivacaine and dexmedetomidine have comparable onset times but provide a longer duration of sensory and motor blocks compared to ropivacaine and dexmedetomidine, thus reducing the postoperative requirement for rescue analgesia. The combination of levobupivacaine and dexmedetomidine may be a better alternative for longer-duration surgeries. |
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| ISSN: | 2249-782X 0973-709X |