“Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block:” A randomized double-blind prospective study

Abstract

Background: The supraclavicular approach to the brachial plexus block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia or used for postoperative pain control for upper extremity surgeries (midhumerus through the hand) and is characteristically associated with a rapid onset of anesthesia and a high success rate. With the increased availability of ultrasound in clinical practice, there is increased ability to identify the plexus with avoidance of vascular and pleural structures, with real time visualization of the needle. Objective: The objective of the study is to compare the efficacy of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for supraclavicular brachial plexus block. Materials and Methods: A prospective, comparative study in patients who underwent upper limb surgeries. Group BD (n = 30): 0.5% inj bupivacaine(1.5mg/kg) with 1mcg/kg of inj. dexmedetomidine Group BF(n=30): 0.5% inj bupivacaine(1.5mg/kg) with 1mcg/kg of inj.fentanyl data analysis was done using SPSS 17.0. Results: The time taken for the onset of sensory and motor blockade was shortened in Group BD compared to Group BF and it was statistically significant. The total duration of sensory, motor blockade, and analgesia was significantly prolonged in Group BD compared to Group BF. Conclusion: Our study shows the onset of sensory blockade was 8.53 ± 1.72 min in the dexmedetomidine group (BD) and 14.80 ± 1.73 min in the fentanyl group (BF) with P = 0.0001 which is statistically highly significant. Addition of dexmedetomidine was better in shortening the onset time of block, in prolonging the duration of supraclavicular brachial plexus block and in improving the postoperative analgesia than the addition of fentanyl used as an adjuvant to bupivacaine and it was without significant adverse effects in patients undergoing upper limb surgeries (mid-humerus through the hand).