ABSTRACT
Background and Aims: Intravenous dexmedetomidine is being increasingly used in perioperative setting including as an adjunct to local anesthetic in various regional techniques with an intent to either improve the block quality, increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolonged postoperative analgesia and reduced post-anesthesia shivering. We aimed to study the effect of intravenous dexmedetomidine on spinal anesthesia with hyperbaric 0.5% bupivacaine
Methodology: One hundred American Society of Anesthesiologists [ASA] physical status I and II patients undergoing orthopaedic surgeries under spinal anesthesia were randomized into two groups of 50 each. After giving spinal anesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine, patients in Group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in Group C received an equivalent quantity of normal saline. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score [RSS], duration of analgesia and side effects of dexmedetomidine were assessed
Results: The time taken for regression of sensory block to S1 dermatome and Bromage 0 motor block was increased significantly by addition of dexmedetomidine. Time to first requirement of analgesic in postoperative period was more in Group D compared to Group C. Sedation was more in patients of Group D compared to Group C [P < 0.001]
Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia
ABSTRACT
Aims and objectives: To study the effect of ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery
Methodology: Thirty American Society of Anesthesiologists [ASA] physical status I and II patients undergoing clavicular surgery, ages 20-60 years were selected. All routine non- invasive monitors were applied and IV line was secured. Ultrasound guided superficial cervical plexus block and interscalene brachial plexus block were given. Injection dexmedetomidine 1 microg/kg infusion over 10 min was started. Block efficacy was evaluated. Any complication or side effects were noted. Sedation was assessed using Ramsay sedation score. Perioperative hemodynamics were charted. Duration of motor block was noted as time of shoulder abduction 3cm from time of block. Duration of analgesia was noted as time for first demand of analgesic from time of block
Results: All the thirty patients allowed clavicular surgeries under combined interscalene brachial plexus and superficial cervical plexus block. No major complications and side effects were noted
Conclusion: USG guided combined superficial cervical plexus and interscalene brachial plexus block are effective for clavicular surgery without any major complication and may be used in place of general anesthesia or blocks by other techniques