Effects of Ultrasound-Guided Supraclavicular Block Using Bupivacaine-Dexmedetomidine or Bupivacaine Alone in Hemodynamics of Patients Undergoing Upper Limb Orthopedic Surgery
-
Ebrahim Espahbodi
,
Seyed Mojtaba Marashi
,
Ali Reza Khajenasiri
,
Mehdi Sanatkar
,
Siamak Yousefi
,
Reza Atef Yekta
Abstract
The aim of this study was to evaluate the effect of bupivacaine with dexmedetomidine in comparison with bupivacaine during supraclavicular block with ultrasound guide on the hemodynamics of patients undergoing upper limb orthopedic surgery. Eighty patients (40 patients in each group) who were candidates for upper limb orthopedic surgery randomly received 30 ml of bupivacaine alone (group 1) or 30 ml of bupivacaine with 20 μg of dexmedetomidine (group 2). The supraclavicular nerve block was performed using an ultrasound guide. Patients' hemodynamic data (including mean arterial blood pressure, heart rate per minute, respiration rate per minute, and peripheral blood oxygen saturation), the onset of action, and duration of sensory-motor block were compared between the two groups. The mean arterial blood pressure during surgery in group 2 was lower than in group 1, but the differences were not statistically significant. The onset of sensory and motor block in group 2 was significantly shorter than in group 1 (P=0.0001). The duration of sensory and motor block in group 2 was significantly longer than in group 1 (P=0.0001). During this study, none of the patients had hemodynamic disturbance or surgical complications. The addition of dexmedetomidine to bupivacaine during the supraclavicular block, in addition to hemodynamic stability of the patient during surgery, increases the duration of sensory and motor block.
1. Casati A, Fanelli G, Albertin A, Deni F, Anelati D, Antonino FA, Beccaria P.Interscalene brachial plexus anesthesia with either 0.5% ropivacaine or 0.5% bupivacaine. Minerva Anestesiol. 2000 Jan-Feb;66(1-2):39-44.
2. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5.
3. Casati A, Fanelli G, Aldegheri G, Berti M, Colnaghi E, Cedrati V, Torri G.Interscalene brachial plexus anaesthesia with 0.5%, 0.75% or 1% ropivacaine: a double-blind comparison with 2% mepivacaine. Br J Anaesth. 1999 Dec;83(6):872-5.
4. Vandepitte C, Gautier P, Xu D, Salviz EA, Hadzic A. Effective volume of ropivacaine 0.75% through a catheter required for interscalene brachial plexus blockade. Anesthesiology. 2013 Apr;118(4):863-7.
5. Techasuk W, González AP, Bernucci F, Cupido T, Finlayson RJ, Tran DQ. A randomized comparison between double-injection and targeted intracluster-injection ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2014 Jun;118(6):1363-9.
6. Jandard C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, Bouaziz H. Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects. Reg Anesth Pain Med. 2002 Jan-Feb;27(1):37-42
7. Dabir S, Mosaffa F, Tanghatari H, Hosseini B. A Randomized, Double-Blind, Comparative Study of the Analgesic Efficacy of Perineural Dexmedetomidine as Adjuvant to Ropivacaine versus Ropivacaine Alone in Ultrasound Guided Saphenous Nerve Block after Anterior Cruciate Ligament Reconstruction Surgery. Arch Anesth & Crit Care. 7(3):123-8.
8. Moshari M, Hosseini B, Seyed Alshohadaei SM, Baghizadeh F. Comparison of Dexamethasone Composition with Bupivacaine and Dexmedetomidine with Bupivacaine and Bupivacaine alone in a Supraclavicular Block with Low Volume. Arch Anesth & Crit Care. 7(1):38-3.
9. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012 Jul-Aug;37(4):410-4.
10. Franco CD, Rahman A, Voronov G, Kerns JM, Beck RJ, Buckenmaier CC 3rd. Gross anatomy of the brachial plexus sheath in human cadavers. Reg Anesth Pain Med. 2008 Jan-Feb;33(1):64-9.
11. Yazer MS, Finlayson RJ, Tran DQ. A randomized comparison between infraclavicular block and targeted intracluster injection supraclavicular block. Reg Anesth Pain Med. 2015 Jan- Feb;40(1):11-5.
12. Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, Chen GZ, Dong YL, Wang W. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One. 2014 Mar 26;9(3):e93114.
13. de Leeuw MA, Slagt C, Hoeksema M, Zuurmond WW, Perez RS. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery. Anesth Analg. 2011 Mar;112(3):719-24.5
14. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, Willatts SM, Grounds RM. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999 Dec;54(12):1136-42.
15. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003 Jun 15;114(9):742-52.
16. Azimaraghi O, Marashi SM, Khazaei N, Pourhassan S, Movafegh A. The Effect of Adding Sufentanil to 0.5% Hyperbaric Bupivacaine on Duration of Brachial Plexus Blockade in Chronic Opium Abusers: a Randomized Clinical Trial. Anesth Pain Med. 2015 Jun 22;5(3):e21960.
17. Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013 Mar;110(3):438-42.
18. Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, Gerner P, Brummett CM. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med. 2014 Jan-Feb;39(1):37-47.
19. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010 Dec;111(6):1548-51.
20. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol. 2010 Mar;27(3):280-4.
21. Rancourt MP, Albert NT, Côté M, Létourneau DR, Bernard PM. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesth Analg. 2012 Oct;115(4):958-62.
22. Nazir O, Yatoo H, Singh S, Kumar A. Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus. Arch Anesth & Crit Care. 7(3):150-6.
23. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015 Apr-Jun;9(2):148-54.
24. Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004 Mar;98(3):835-40, table of contents.
25. Kalappa S, Sridhara RB, Kumaraswamy S. Dexmedetomidine as an Adjuvant to Pre Emptive Caudal Epidural Ropivacaine for Lumbosacral Spine Surgeries. J Clin Diagn Res. 2016 Jan;10(1):UC22-4.
26. Kamal M, Agarwal D, Singariya G, Kumari K, Paliwal B, Ujwal S. Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial. J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):255-260.
27. Singh N, Gupta S, Kathuria S. Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):238-243.
28. Kumari P, Singh RB, Saurabh K, Pal S, Ram GK, Anand RK. To Compare the Efficacy of Postoperative Analgesia between Clonidine and Dexmedetomidine as Adjuvants with 0.5% Ropivacaine by Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective, Double-Blind, Randomized Study. Anesth Essays Res. 2020 Oct- Dec;14(4):644-652.
29. Sehmbi H, Brull R, Ceballos KR, Shah UJ, Martin J, Tobias A, Solo K, Abdallah FW.
Perineural and intravenous dexamethasone and dexmedetomidine: network meta-analysis of adjunctive effects on supraclavicular brachial plexus block. Anaesthesia. 2021 Jul;76(7):974- 990.
30. Mostafa MF, Aal FAA, Ali IH, Ibrahim AK, Herdan R. Dexmedetomidine during
suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study. Korean J Pain. 2020 Jan 1;33(1):81-89
2. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5.
3. Casati A, Fanelli G, Aldegheri G, Berti M, Colnaghi E, Cedrati V, Torri G.Interscalene brachial plexus anaesthesia with 0.5%, 0.75% or 1% ropivacaine: a double-blind comparison with 2% mepivacaine. Br J Anaesth. 1999 Dec;83(6):872-5.
4. Vandepitte C, Gautier P, Xu D, Salviz EA, Hadzic A. Effective volume of ropivacaine 0.75% through a catheter required for interscalene brachial plexus blockade. Anesthesiology. 2013 Apr;118(4):863-7.
5. Techasuk W, González AP, Bernucci F, Cupido T, Finlayson RJ, Tran DQ. A randomized comparison between double-injection and targeted intracluster-injection ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2014 Jun;118(6):1363-9.
6. Jandard C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, Bouaziz H. Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects. Reg Anesth Pain Med. 2002 Jan-Feb;27(1):37-42
7. Dabir S, Mosaffa F, Tanghatari H, Hosseini B. A Randomized, Double-Blind, Comparative Study of the Analgesic Efficacy of Perineural Dexmedetomidine as Adjuvant to Ropivacaine versus Ropivacaine Alone in Ultrasound Guided Saphenous Nerve Block after Anterior Cruciate Ligament Reconstruction Surgery. Arch Anesth & Crit Care. 7(3):123-8.
8. Moshari M, Hosseini B, Seyed Alshohadaei SM, Baghizadeh F. Comparison of Dexamethasone Composition with Bupivacaine and Dexmedetomidine with Bupivacaine and Bupivacaine alone in a Supraclavicular Block with Low Volume. Arch Anesth & Crit Care. 7(1):38-3.
9. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012 Jul-Aug;37(4):410-4.
10. Franco CD, Rahman A, Voronov G, Kerns JM, Beck RJ, Buckenmaier CC 3rd. Gross anatomy of the brachial plexus sheath in human cadavers. Reg Anesth Pain Med. 2008 Jan-Feb;33(1):64-9.
11. Yazer MS, Finlayson RJ, Tran DQ. A randomized comparison between infraclavicular block and targeted intracluster injection supraclavicular block. Reg Anesth Pain Med. 2015 Jan- Feb;40(1):11-5.
12. Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, Chen GZ, Dong YL, Wang W. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One. 2014 Mar 26;9(3):e93114.
13. de Leeuw MA, Slagt C, Hoeksema M, Zuurmond WW, Perez RS. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery. Anesth Analg. 2011 Mar;112(3):719-24.5
14. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, Willatts SM, Grounds RM. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999 Dec;54(12):1136-42.
15. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003 Jun 15;114(9):742-52.
16. Azimaraghi O, Marashi SM, Khazaei N, Pourhassan S, Movafegh A. The Effect of Adding Sufentanil to 0.5% Hyperbaric Bupivacaine on Duration of Brachial Plexus Blockade in Chronic Opium Abusers: a Randomized Clinical Trial. Anesth Pain Med. 2015 Jun 22;5(3):e21960.
17. Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth. 2013 Mar;110(3):438-42.
18. Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, Gerner P, Brummett CM. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med. 2014 Jan-Feb;39(1):37-47.
19. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010 Dec;111(6):1548-51.
20. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol. 2010 Mar;27(3):280-4.
21. Rancourt MP, Albert NT, Côté M, Létourneau DR, Bernard PM. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesth Analg. 2012 Oct;115(4):958-62.
22. Nazir O, Yatoo H, Singh S, Kumar A. Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus. Arch Anesth & Crit Care. 7(3):150-6.
23. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015 Apr-Jun;9(2):148-54.
24. Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004 Mar;98(3):835-40, table of contents.
25. Kalappa S, Sridhara RB, Kumaraswamy S. Dexmedetomidine as an Adjuvant to Pre Emptive Caudal Epidural Ropivacaine for Lumbosacral Spine Surgeries. J Clin Diagn Res. 2016 Jan;10(1):UC22-4.
26. Kamal M, Agarwal D, Singariya G, Kumari K, Paliwal B, Ujwal S. Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial. J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):255-260.
27. Singh N, Gupta S, Kathuria S. Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):238-243.
28. Kumari P, Singh RB, Saurabh K, Pal S, Ram GK, Anand RK. To Compare the Efficacy of Postoperative Analgesia between Clonidine and Dexmedetomidine as Adjuvants with 0.5% Ropivacaine by Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective, Double-Blind, Randomized Study. Anesth Essays Res. 2020 Oct- Dec;14(4):644-652.
29. Sehmbi H, Brull R, Ceballos KR, Shah UJ, Martin J, Tobias A, Solo K, Abdallah FW.
Perineural and intravenous dexamethasone and dexmedetomidine: network meta-analysis of adjunctive effects on supraclavicular brachial plexus block. Anaesthesia. 2021 Jul;76(7):974- 990.
30. Mostafa MF, Aal FAA, Ali IH, Ibrahim AK, Herdan R. Dexmedetomidine during
suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study. Korean J Pain. 2020 Jan 1;33(1):81-89
| Files | ||
| Issue | Vol 60 No 10 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i10.11553 | |
| Keywords | ||
| Regional anesthesia Dexmedetomidine Bupivacaine Supraclavicular nerve block | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Espahbodi E, Marashi SM, Khajenasiri AR, Sanatkar M, Yousefi S, Atef Yekta R. Effects of Ultrasound-Guided Supraclavicular Block Using Bupivacaine-Dexmedetomidine or Bupivacaine Alone in Hemodynamics of Patients Undergoing Upper Limb Orthopedic Surgery. Acta Med Iran. 2022;60(10):622-627.
