EVALUATION OF THE EFFECT OF ORAL CLONIDINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK WITH BUPIVACAINE AND DEXAMETHASONE

Dr. Abul Ishrat*, Dr. Sahin Sultana Chowdhury, Dr. Moumita Talukder, Dr. Rebeka Sultana and Dr. Malaya Kumar Das

ABSTRACT

Background: Brachial plexus block is gaining popularity day by day over general anaesthesia for upper extremity surgeries. However, the quality of anaesthesia and analgesia depends on using adjuvant to local anaesthetics. It is previously reported that clonidine used as an adjuvant to bupivacaine increases duration of analgesia. As a premedication clonidine has some benefits such as sedation, analgesia and anxiolysis in regional anaesthesia practice. Objectives: The present study was conducted to evaluate the effects of oral clonidine premedication upon the quality of anaesthesia and analgesia, haemodynamic status and adverse effects in supraclavicular brachial plexus block with bupivacaine and dexamethasone in patients undergoing upper limb surgeries. Methods: A total number of 60 patients of American Society of Anaesthesiologists physical status class I and II were randomized double blindly into two groups of 30 patients in each. Group-C(case group) received tablet Clonidine (100mcg) and Group-B(control group) received tablet Vitamin B complex as a placebo,45 minutes before the block procedure with sips of water. Both Group C and Group B patients was blocked with 15 ml of 0.5% bupivacaine + 1 ml dexamethsone + 4 ml distilled water under ultrasound guidance. All observations (haemodynamic variables, oxygen saturation, level of sedation, onset and duration of sensory and motor block, duration of analgesia, post-operative pain score in VAS, first analgesic demand, side effects) were also assessed and recorded. Datas were collected in preformed data collection sheet and analyzed by the statistical packages for social science (SPSS) software (version 23.0). Results: In this study, onset of sensory block was found 7.6±0.8 minute in group C and 13.0±1.4 minute in group B. The difference was statistically significant (p<0.05) between two groups. The onset of motor block was found 18.3±1.1 minute in group C and 18.7±1.8 minute in group B,which wsa not statistically significant (p=0.3031). Duration of sensory block was found 652.9±35.6 minute in group C and 454.2±30.8 minute in group B. Duration of motor block was found 574.5±34.3 minute in group C and 366.1±51.2 minute in group B. The differences were statistically significant (p<0.05) between two groups. Duration of analgesia was found 731.8±41.8 minute in group C and 528.8±47.7 minute in group B. The difference was statistically significant (p<0.05) between two groups. After 9 hours, mean VAS score was found 0.03±0.21 in group C and 3.6±1.3 in group B, after 13 hour, mean VAS score was found 3.6±1.38 in group C. The difference was statistically significant (p<0.05) between two groups. After 90 minutes, mean Ramsay sedation score was found 2.73±0.44 in group C and 1.17±0.46 in group B. After 105 minutes, mean Ramsay sedation score was found 2.93±0.25 in group C and 1.13±0.34 in group B, which were statistically significant (p<0.05) between two groups. Mean arterial pressure- after 5 min, after 10 min, after 15 min, after 30 min, after 45 min, after 1 hour, after 2 hour, after 3 hour and after 4 hour were significantly (p<0.05) higher in group B than group C. 13 (43.3%) patients had dry mouth in group C and 2(6.7%) in group B, which was significant (p<0.05) but other complains were not significant (p>0.05) between two groups. 2 (6.7%) patients in group C and 29 (96.7%) patients in group B were found one time requirement of rescue analgesic within 12 hours of postoperative period according to VAS. The difference was significant (p<0.05) between two groups. Conclusion: Addition of clonidine as premedication in supraclavicular brachial plexus block with bupivacaine and dexamethasone ensures better quality of block, better quality of anaesthesia by reducing complications and longer duration of post-operative analgesia with moderate sedation.

Keywords: Bupivacaine, dexamethasone, anaesthesia, analgesia.