Iyer Lakshmi S, Bhat Shreyas S, Nethra H N, Vijayakumar H N, Sudheesh K
Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Anesth Essays Res. 2021 Oct-Dec;15(4):443-447. doi: 10.4103/aer.aer_145_21. Epub 2022 Mar 30.
CONTEXT: Dexmedetomidine, an α-agonist, has been studied widely as an adjuvant to local anesthetics in regional anesthesia techniques to enhance the quality and duration of analgesia (DOA). It was hypothesized that addition of dexmedetomidine 0.5 ug.kg to levobupivacaine would prolong the DOA. AIMS: We aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor blockade, and duration of analgesia. SETTINGS AND DESIGN: This was a prospective randomized double-blind study carried out at a tertiary hospital attached to medical college. SUBJECTS AND METHODS: Sixty American Society of Anesthesiologists PS Class I and II patients aged between 18 and 60 years of either sex, undergoing elective upper-limb surgery lasting more than 30 min, were included in the study. They were randomly divided into two groups of thirty each to receive ultrasound-guided supraclavicular brachial plexus block. Group L was given nerve block with 20 mL of 0.25% levobupivacaine and 1 mL saline, and Group D received 20 mL of 0.25% levobupivacaine with 0.5 ug.kg of dexmedetomidine (diluted to volume of 1 mL). Onset time and duration of sensory and motor blockade, time to first rescue analgesia, and hemodynamic parameters were recorded. STATISTICAL ANALYSIS USED: Chi-square test for qualitative variables and Student's unpaired "" test for continuous variables were used for statistical analysis. RESULTS: The onset of sensory and motor blockade was 6.51 ± 0.77 min and 10.71 ± 0.34 min in Group D and 9.9 ± 0.45 and 15.93 ± 1.92 min in Group L, respectively ( < 0.005). DOA was 9.53 ± 0.29 h in Group D and 3.89 ± 0.30 h in Group L ( < 0.001). The duration of sensory and motor block was 9.14 ± 0.19 h and 8.55 ± 0.31 h in Group D and 6.15 ± 3.02 and 5.61 ± 2.98 h in Group L, respectively ( < 0.005). No adverse effects were observed in either of the groups. CONCLUSIONS: Addition of 0.5 ug.kg of dexmedetomidine to 20 mL 0.25% levobupivacaine in ultrasound guided (USG)-guided supraclavicular brachial plexus block shortens the onset time of sensory and motor blockade and prolongs duration of sensory and motor block and DOA.
背景：右美托咪定是一种α受体激动剂，作为局部麻醉药的辅助剂在区域麻醉技术中已被广泛研究，用于提高镇痛质量和持续时间（镇痛持续时间）。研究假设是在左旋布比卡因中添加0.5μg/kg右美托咪定可延长镇痛持续时间。 目的：我们旨在评估右美托咪定作为左旋布比卡因辅助剂用于锁骨上臂丛神经阻滞时，在感觉和运动阻滞的起效时间和持续时间以及镇痛持续时间方面的疗效。 设置与设计：这是一项在医学院附属医院进行的前瞻性随机双盲研究。 对象与方法：纳入60例年龄在18至60岁之间、美国麻醉医师协会（ASA）分级为I级和II级、接受持续时间超过30分钟的择期上肢手术的患者，性别不限。他们被随机分为两组，每组30例，接受超声引导下锁骨上臂丛神经阻滞。L组给予20mL 0.25%左旋布比卡因加1mL生理盐水进行神经阻滞，D组接受20mL 0.25%左旋布比卡因加0.5μg/kg右美托咪定（稀释至1mL体积）。记录感觉和运动阻滞的起效时间和持续时间、首次补救镇痛时间以及血流动力学参数。 统计分析方法：定性变量采用卡方检验，连续变量采用学生氏非配对t检验进行统计分析。 结果：D组感觉和运动阻滞的起效时间分别为6.51±0.77分钟和10.71±0.34分钟，L组分别为9.9±0.45分钟和15.93±1.92分钟（P<0.005）。D组镇痛持续时间为9.53±0.29小时，L组为3.89±0.30小时（P<0.001）。D组感觉和运动阻滞的持续时间分别为9.14±0.19小时和8.55±0.31小时，L组分别为6.15±3.02小时和5.61±2.98小时（P<0.005）。两组均未观察到不良反应。 结论：在超声引导下的锁骨上臂丛神经阻滞中，于20mL 0.25%左旋布比卡因中添加0.5μg/kg右美托咪定可缩短感觉和运动阻滞的起效时间，延长感觉和运动阻滞的持续时间以及镇痛持续时间。
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