Deba Gopal Pathak, Manmayoori Phatowali


Background and aims:-Adjuvants are often used with local anaesthetics in supraclavicular brachial plexus block(SBPB) for its synergistic effect by prolonging the duration of sensory and motor block. Alpha 2 agonists, clonidine and dexmedetomidine are combined with local anaesthetics to extend the duration of regional anaesthesia.The purpose of this study was to compare the effects of clonidine and dexmedetomidine as an adjuvant to bupivacaine(0.25%) in Supraclavicular brachial plexus block(SBPB) with respect to the hemodynamic variations;onset,duration of sensory and motor block along with duration of analgesia.

Methodology:-A randomized double blind prospective study involving 75 patients aged between 18 and 60yrs of ASA status I and II undergoing upper limb surgeries under SBPB was carried out at SMCH.The patients were randomly divided into three groups:Group B–received 35 ml of 0.25% Bupivacaine with 2ml of 0.9% normal saline,GroupC–received 35 ml of 0.25 % Bupivacaine with Clonidine 1μg/kg mixed with 0.9% normal saline to make total volume of 2ml and GroupD–received 35ml of Bupivacaine 0.25% with Dexmedetomidine 1μg/kg mixed with 0.9% normal saline to make a total volume of 2ml.Heart rate,systolic and diastolic blood pressure; onset and duration of sensory blocks, motor blocks and duration of analgesia;sedation and adverse effects,if any,were assessed.

Results:The groups were comparable with respect to age,sex,weight,ASA status and surgical characteristics.The mean onset of sensory and motor blockade and mean duration of sensory and motor blockade were faster and prolonged in Group D in comparison to Group C and Group B which were statistically highly significant(p<0.001).Hypotension,bradycardia, sedation and decreased respiratory rate were seen in few patients in Dexmedetomidine group.

Conclusion: We conclude that dexmedetomidine can be a better alternative to clonidine when administered with Bupivacaine as an adjuvant for SBPB for upper limb surgeries.


Clonidine,dexmedetomidine,supraclavicular brachial plexus block

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De Jong R.Regional anaesthesia and analgesia.Philadelphia, Pa:Saunders;1996.Local anesthetic pharmacology.In Brown DL,ed; pp.124–42.

Bazin JE,Massoni C,Bruelle P,Fenies V,Groslier D,Schoeffler P.The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil. Anaesthesia.1997;52(9):858–862.

Bone HG,Van Aken H, Booke M,Bürkle H.Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine.Reg Anesth Pain Med. 1999;24(5):405–410.

Keeler JF,Simpson KH, Ellis FR, Kay SP.Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block.BJA Br J Anaesth.1992;68(1):68–71.

JC Eisenach, M De Kock, W Klimscha α2-Adrenergic agonists for regional anesthesia Anesthesiology,85 (1996), pp. 655-674

Virtanen R, Savola JM, Saano V, Nyman L.Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist.Eur J Pharmacol. 1988 May 20;150(1–2):9–14.

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 EJA.2010;27(3):280–284.

Rancourt M-PM, Albert NT, Côté M, Létourneau D-R, Bernard P-M.Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine.Anesth Analg.2012;115(4):958–962.

Eledjam JJ, Deschodt J, Viel EJ, Lubrano JF, Charavel P, d’Athis F, et al.Brachial plexus block with bupivacaine:effects of added alpha-adrenergic agonists:comparison between clonidine and epinephrine.Can J Anaesth.1991;38(7):870–875.

Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R.Controlled sedation with alphaxalone-alphadolone.Br Med J.1974;2(5920):656–659.

Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E.High concentrations of dexmedetomidine inhibit compound action potentials in frog sciatic nerves without α2 adrenoceptor activation.Br J Pharmacol.2010;160(7):1662–1676.

El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth.2009;103(2):268–274.

Brummett CM, Amodeo FS, Janda AM, Padda AK, Lydic R.Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block.2010;

Strichartz GR.The alpha 2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers.Anesth Analg.1993;76:295–301.

Gaumann D, Forster A, Griessen M, Habre W, Poinsot O, Santa Della D.Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block.Anesth Analg.1992;75(1):69–74.

Gaumann DM, Brunet PC, Jirounek P. Clonidine enhances the effects of lidocaine on C-fiber action potential.Anesth Analg. 1992;74(5):719–725.

Chen B-S, Peng H, Wu S-N. Dexmedetomidine, an α2-adrenergic agonist, inhibits neuronal delayed-rectifier potassium current and sodium current.Br J Anaesth. 2009;103(2):244–254.

Maruta T, Nemoto T, Satoh S, Kanai T, Yanagita T, Wada A, et al. Dexmedetomidine and clonidine inhibit the function of Na v 1.7 independent of α 2-adrenoceptor in adrenal chromaffin cells.J Anesth. 2011;25(4):549.

Guo T-Z, Jiang J-Y, Buttermann AE, Maze M.Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology. 1996;84(4):873–881.

Swami SS, Keniya VM, Ladi SD, Rao R.Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block:A randomised double-blind prospective study. Indian J Anaesth. 2012;56(3):243.

Rao KG, Kapoor P, Chaurasiya MK, Shukla A.A randomised double blind prospective study to compare clonidine and dexmedetomidine as an adjuvant in supra-clavicular brachial plexus block. Indian J Fundam Appl Life Sci. 2014;4:226–29.

Kirubahar R, Sundari B, Kanna V. Comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block for upper limb orthopedic procedures. Int J Res Med Sci. 2016;4:1172–1176.

Kakad R, Chaudhari D, Lawhale S, Ghodki SG, Bite BM.Comparative study between dexmedetomidine and clonidine as an adjunct to bupivacaine in brachial plexus block in orthopaedic surgeries. J Contemp Med Dent. 2015;3:39–43.

Sebastian D, Ravi M, Dinesh K, Somasekharam P.Comparison of dexmedetomidine and clonidine as adjuvant to ropivacaine in supraclavicular brachial plexus nerve blocks. IOSR J Dent Med Sci. 2015;14:91–97.

Chakraborty S, Chakrabarti J, Mandal MC, Hazra A, Das S.Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block:A randomized controlled trial.Indian J Pharmacol.2010;42(2):74.

Gandhi R, Shah A, Patel I.Use of dexmedetomidine along with bupivacaine for brachial plexus block. Natl J Med Res. 2012;2(1):67–9.


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