Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block

Dexmedetomidine as an adjuvant to local anesthetics in peripheral nerve blocks has been used in only a few studies. We aimed at assessing the effect of dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Random, controlled, and triple blind. Sixty American Society of Anesthesiologist grade I and II patients of either sex scheduled for elective upper limb surgery under supraclavicular brachial plexus block were divided into three equal groups in a prospective randomized double-blind controlled manner. For block patients in Group C received 0.5% ropivacaine [30cc], 0.5% ropivacaine with 50 microg dexmedetomidine [30cc] in Group D and 0.5% ropivacaine [30cc] in Group D-IV along with intravenous infusion of 50 microg dexmedetomidine in normal saline. IBM-SPSS software version 17, Chi-square test, Mann-Whitney U-test. Demographic profile and surgical characteristics were similar in all the three groups. Sensory block and motor block onset was earlier in group D than in group D-IV and group C. The sensory block and motor block duration was also prolonged in group D when compared with group D-IV and group C. The duration of analgesia was significantly longer in group D and D-IV when compared to group C. Dexmedetomidine as an adjuvant to 0.5%ropivacaine in ultrasound guided brachial plexus block shortens the sensory as well as motor block onset time, prolongs sensory and motor block duration and also increases the duration of analgesia. The action of dexmedetomidine most probably is local rather than centrally mediated

comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery

The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg [Group A], 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 ?g sufentanil [Group B] or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 ?g butorphanol [Group C]. Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared. Analysis of variance [ANOVA], post hoc test and Chi-square test were used. Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block [DOSB] compared with bupivacaine alone [DOSB being 156.83 +/- 23.83 min, 170.87 +/- 22.21 min and 171.17 +/- 23.99 min in groups A, B and C, respectively] without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 +/- 46.3 min, 323 +/- 65.0 min and 299 +/- 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus [60%].The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group of patients who have multiple co-morbid conditions