Brachial Plexus Block
Conditions
Keywords
Brachial plexus block, Ropivacaine, Dexmedetomidine, Dexamethasone, Adjuvants, anesthesia
Brief summary
The investigators want to compare the effectiveness of dexamethasone and dexmedetomidine as an adjuvant to 0.5% ropivacaine for supraclavicular brachial plexus block on the onset of block and duration of analgesia, so that the investigators can choose the better adjuvant for the investigators routine practice of regional anesthesia.
Detailed description
Ropivacaine is a newer local anesthetic which is structurally related to bupivacaine, but has fewer side effects. It is more cardio stable than bupivacaine, but the onset of action is delayed and the duration of action is shorter than bupivacaine making its use during regional anesthesia less preferable to many anesthesiologists. Steroids like dexamethasone, or alpha-2 agonists like dexmedetomidine are being studied as adjuvants to ropivacaine for brachial plexus block to improve its anesthetic properties and have shown favorable outcome in terms of shortening the onset of block and prolonging the duration of action. But no study has been done to compare their effects. So in this study the investigators want to compare the effectiveness of dexamethasone and dexmedetomidine as an adjuvant to 0.5% ropivacaine for supraclavicular brachial plexus block on the onset of block and duration of analgesia, so that the investigators can choose the better adjuvant for the investigators routine practice of regional anesthesia.
Interventions
DRUGRopivacaine and Normal saline
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 1 ml normal saline
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 4mg (1ml) dexamethasone
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 50 mcg (1ml) dexmedetomidine
Sponsors
B.P. Koirala Institute of Health Sciences
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients of American Society of Anesthesiologists Physical Status I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block
Exclusion criteria
* Patient's refusal to participate * Patients weighing less than 40 kg * Allergy to study drugs * Infection at the site of injection * Patients with preexisting neurological deficit * Patients with diabetes mellitus * Patients on steroids preoperatively * Patients with bleeding disorder or coagulopathy * Abnormalities in ECG like AV block or symptomatic bradycardia * Patients receiving adrenoreceptor agonist or antagonist therapy preoperatively * Requirement of conversion to general anesthesia due to inadequate block
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Onset of sensory block | every 3 minutes until 45 minutes after injection of drug | Sensory block in the territories of median nerve (palmar surface of index finger), ulnar nerve (palmar surface of little finger), radial nerve (dorsal surface of first web space/ thumb) and musculocutaneous nerve (lateral side of volar surface of forearm) will be assessed by pinprick test using a 3-point scale: 0 - normal sensation, 1. \- loss of sensation of pinprick (analgesia), 2. \- loss of sensation of touch (anaesthesia). Complete sensory block will be defined as grade 2 sensory block in 3 or more nerve territories. |
| Onset of motor block | every 3 minutes until 45 minutes after injection of drug | Motor block will be evaluated by thumb flexion/ opposition (median nerve), thumb extension (radial nerve), finger abduction (ulnar nerve) and elbow flexion with forearm in full supination (musculocutaneous nerve) on a 3-point scale for motor function: 0 - normal motor function, 1. \- reduced motor strength but able to move, 2. \- complete motor block. Complete motor block will be defined as grade 2 motor block in 3 or more nerve territories. |
| Duration of analgesia | Up to 24 hours after onset of block | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of sensory block | Up to 24 hours after onset of block | time from onset of sensory block to complete recovery of anaesthesia on all nerves. |
| Duration of motor block | Up to 24 hours after onset of block | time from onset of motor block to the recovery of complete motor function of the hand and forearm |
| Incidence of side effects of drugs | Forty-eight hours following the injection of local anesthetics | Side effects like bradycardia, tachycardia, hypotension, sedation, neurological deficit will be evaluated |
Countries
Nepal
Outcome results
None listed