Clonidine as an adjuvant for ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet: A clinical study.

BACKGROUND AND AIMS: Clonidine has been used as an adjuvant to local anesthetic to extend the duration of block. The present study was aimed to compare the onset and duration of sensory and motor blockade of 0.75% ropivacaine alone or in combination with clonidine during ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet. MATERIALS AND METHODS: Sixty four adult American Society of Anesthesiologist grade 1 and 2 patients, scheduled for upper extremity surgeries were randomized to receive either 19.8 mL of 0.75% ropivacaine with 0.2 mL of normal saline (Group R) or 0.2 mL (30 µg) of clonidine (Group RC) in supraclavicular block. Onset and duration of sensory and motor blockade was compared. The hemodynamic variability, sedation, respiratory adequacy and any other adverse effects were also recorded. RESULT: Ultrasound helped to visualize the nerves, needle and spread of local anesthetic at the brachial plexus block site. There was no statistically significant difference in the onset of sensory and motor blockade between the groups. Surgical anesthesia was achieved at the mean time of 20 min in all patients. Prolonged post-operative analgesia (mean duration 956 min) was observed in RC group as compared with R group (736 min). No complication of technique or adverse effect of ropivacaine and clonidine was reported. CONCLUSION: Clonidine as an adjuvant to ropivacaine for ultrasound guided supraclavicular brachial plexus enhanced duration of post-operative analgesia. There was no incidence of vessel puncture or pneumothorax.

Ropivacaine: Anesthetic consideration in elderly patients for transurethral resection of prostrate a clinical trial.

BACKGROUND: Ropivacaine has less systemic toxicity and greater differentiation of sensory and motor blockade after subarachnoid block. This study was aimed to evaluate the anesthetic efficacy of intrathecal 0.75% isobaric ropivacaine alone or with fentanyl in elderly patients undergoing transurethral resection of prostrate. MATERIALS AND METHODS: Fifty four elderly consented patients of ASA grade I-III scheduled for transurethral resection of prostrate under the subarachnoid block were randomized to receive either intrathecal 4 mL of 0.75% isobaric ropivacaine (Group R, n = 27) or 3.5 mL of 0.75% isobaric ropivacaine with 0.5 mL (25 µg) of fentanyl (Group RF, n = 27). The characteristics of sensory and motor blockade, intraoperative hemodynamic changes, and secondary effects were noted for evaluation. RESULTS: There was no significant difference in the demographic profile of patients. The surgical anesthesia was adequate for TURP surgery in all patients. The median time to achieve the sensory blockade at T10 dermatome was 3.2 ± 1.5 min in Group R and 3.5 ± 1.3 min in Group RF. The median duration of sensory blockade at T10 was 130.6 ± 10.2 min in Group R and 175.8 ± 8.6 min in Group RF. The median duration of complete motor block was significantly shorter than the duration of sensory blockade (P < 0.001). There were fewer episodes of manageable hypotension in 5 patients of Group R and 11 patients of Group RF. No secondary effects have occurred in any patients. CONCLUSION: The intrathecal 0.75% isobaric ropivacaine alone or with fentanyl has provided effective surgical anesthesia for transurethral resection of prostrate and hemodynamic stability in elderly patients.