Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block

Usha K. Chaudhary, Amruth Danesh, Monika Mahajan, Sudarshan Kumar, Versha Verma, Bhanu Awasthi


Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block.

Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher’s exact test.

Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block.

Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.


Clonidine, Dexmedetomidine, Supraclavicular block, USG guided supraclavicular block

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Rupera KB, Khar BN, Shah VR, Parikh BK. Supraclavicular brachial plexus block: ultrasonography guided technique offer advantage over peripheral nerve stimulator guided technique. National J Med Res. 2013;3:241-4.

Singh S, Aggarwal A. A randomized controlled double-blinded prospective study of the efficacy of clonidine added to bupivacaine as compared with bupivacaine alone used in supraclavicular brachial plexus block for upper limb surgeries. Indian J Anaesth. 2010;54:552-7.

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. Reg Anesth Pain Med. 2010;35:427-31.

Erlacher W, Schuschnig C, Orlicek F, Marhofer P, Koinig H, Kapral S. Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block. Can J Anesth. 2001;48:522-5.

Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg. 2008;107:96-101.

Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiol. 2008;109:502-11.

Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in Pediatrics. Acta Anaesthesiol Scand. 2009;53:251-6.

Sebastian D, Ravi M, Dinesh K, Somasekharam P. Comparison of dexmedetomidine and clonidine as adjuvant to ropivacaine in supraclavicular brachial plexus nerve blocks. IOSR-JDMS. 2015;14:91-7.

Swami SS, Kenya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: randomized double blind prospective study. Indian J Anaesth. 2012;56:24.

Ammar AS, Mahmoud KM. Ultrasound guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi J Anaesth. 2012;6:109-14.

Harper GK, Stafford MA, Hill DA. Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study. Br J Anaesth. 2010;104:633-6.

Nakamura M, Ferreira SH. Peripheral analgesic action of clonidine: Mediation by release of endogenous encephalin like substances. Eur J Pharmacol. 1988;146:223-8.

Birnbaumer L, Abramowitz J, Brown AM. Receptor effector coupling by G proteins. Biochem Biophys Acta. 1990;1031:163-224.

Chakraborty S, Chakrabarti J, Mandal M C, Hazra A, Das S. Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial. Indian J Pharmacol. 2010;42:74-7.

Chaudhary SK, Verma RK, Rana S, Singh J, Gupta B, Singh Y. Ultrasound-guided femoro-sciatic nerve block for post-operative analgesia after below knee orthopaedic surgeries under subarachnoid block: Comparison between clonidine and dexmedetomidine as adjuvants to levobupivacaine. Indian J Anaesth. 2016;60:484-90.

Patil KN, Singh ND. Clonidine as an adjuvant to ropivacaine induced supraclavicular brachial plexus block for upper limb surgeries. J Anaesthesiol Clin Pharmacol. 2015;3:365-9.