Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Analytical Study on Trial of Scar using Flamm and Geiger Admission Scoring System for VBAC

Introduction: The strength of the uterine scar and its capacityto withstand the stress of subsequent pregnancy and laborcannot be completely assessed or guaranteed in advance.Hence the present study was undertaken to analyse factorsstated by Flamm and Geiger admission scoring system andother plausible factors for successful TOLAC.Material and methods: A total of 265 cases of a previous CSwere selected. Booked cases were regularly followed up inthe antenatal clinic and the unbooked patients, who reporteddirectly for labor, were then assessed for a trial of vaginaldelivery.Result: A total of 265 cases were eligible for trial of scar usingFlamm and Geiger Admission scoring system. 135 had VBACwhereas in 130 cases trial was terminated and had ERCS.Out of 130 ERCS, 73.4% were because of scar tenderness,whereas 16.4% had non reassuring fetal heart rate. Remaininghad unsuccessful progress of labor.Conclusion: Flamm and Geiger admission scoring systemcan be used to successfully predict the likelihood of vaginaldelivery after a trial of scar, thereby reducing maternal andfetal morbidity and rate of caesarean section. Decisionregarding trial should also include factors like eventfulprevious pregnancy, interpregnancy interval, gestational ageand estimated fetal weight. Successful trial can be increasedby regular antenatal visits, general health promotion, earlydetection and management of high risk factors. Adequate interpregnancy interval should be encouraged by promoting andoffering contraception.