Reddy Bhumireddy Suneel, Gaude Yogesh K, Vaidya Shriram, Kini Gurudas K, Budania Lokvendra S, Eeshwar M V
Department of Anaesthesiology, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India.
Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):371-377. doi: 10.4103/joacp.JOACP_289_18. Epub 2021 Oct 12.
Levobupivacaine, a less cardiotoxic s-isomer of bupivacaine, is proved to be similar to bupivacaine, hence, proposed as a safer alternative for nerve blocks. We aimed to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block (BPB) performed with levobupivacaine. The aim of this study is to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular BPB performed with levobupivacaine.
A prospective, randomized double-blind control trial done on 120 patients undergoing elective upper limb surgical procedures under supraclavicular BPB. The enrolled patients were allocated to one of the three groups: Group L - 0.5% levobupivacaine +0.9% normal saline (NS) IV infusion; Group LDI - 0.5% levobupivacaine + dexmedetomidine (1 mcg/kg) in NS IV infusion; and Group LDP - 0.5% levobupivacaine +1 mcg/kg of dexmedetomidine perineural + NS IV infusion. The onset and duration of sensory and motor blockade were recorded in minutes. One-way ANOVA was used to observe any differences between the groups, and post hoc comparisons were conducted after Bonferroni correction for multiple comparisons.
The onset of sensory and motor blockade in Group LDP was significantly shorter than Group L and Group LDI. The duration of sensory blockade in Group LDP was significantly longer than Group LDI and Group L. The duration of motor blockade in Group LDP was prolonged compared to Group LDI and Group L.
When dexmedetomidine is added as adjunct to levobupivacaine in supraclavicular BPB, onset of sensory and motor blockade is faster in perineural group, whereas duration of sensory and motor blockade and duration of analgesia are more prolonged when used perineurally than intravenously.
左旋布比卡因是布比卡因心脏毒性较小的S-异构体，已被证明与布比卡因相似，因此被提议作为神经阻滞更安全的替代药物。我们旨在评估神经周围和静脉注射右美托咪定对左旋布比卡因超声引导下锁骨上臂丛神经阻滞（BPB）特征的影响。本研究的目的是评估神经周围和静脉注射右美托咪定对左旋布比卡因超声引导下锁骨上BPB特征的影响。
一项前瞻性、随机双盲对照试验，对120例在锁骨上BPB下进行择期上肢手术的患者进行。入选患者被分为三组之一：L组——0.5%左旋布比卡因+0.9%生理盐水（NS）静脉输注；LDI组——0.5%左旋布比卡因+右美托咪定（1 mcg/kg）于NS中静脉输注；LDP组——0.5%左旋布比卡因+1 mcg/kg右美托咪定神经周围注射+NS静脉输注。感觉和运动阻滞的起效时间和持续时间以分钟记录。采用单因素方差分析观察各组间的差异，并在进行Bonferroni校正以进行多重比较后进行事后比较。
LDP组感觉和运动阻滞的起效时间明显短于L组和LDI组。LDP组感觉阻滞的持续时间明显长于LDI组和L组。LDP组运动阻滞的持续时间比LDI组和L组延长。
在锁骨上BPB中，当右美托咪定作为左旋布比卡因的辅助药物添加时，神经周围组感觉和运动阻滞的起效更快，而神经周围使用时感觉和运动阻滞的持续时间以及镇痛持续时间比静脉使用时更长。
