A double blind randomized study to assess the addition of clonidine to ropivacaine in supraclavicular brachial plexus block

Shantanu B. Kulkarni, Balasaheb T. Govardhane, Praveen Shambu


Background: The supraclavicular brachial plexus block provides anesthesia of the entire upper extremity in consistent and time-efficient manner. Ropivacaine is an amide, local anaesthetic agent, eliciting nerve block in brachial plexus. Clonidine as an adjuvant to ropivacaine enhances the quality and duration of analgesia when given epidurally or intrathecally. The aim of the present study was to assess the effect of adding clonidine to ropivacaine in supraclavicular brachial plexus block.

Methods: Sixty patients were randomly divided into two groups, Group C and R. Group C received 0.5% of ropivacaine with 1 ml normal saline while Group R received same amount of ropivacaine with 1 ml (equivalent to 100μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia, intra and post-operative hemodynamic changes and sedation scores.

Results: There was a significant increase in duration of sensory and motor block and duration of analgesia in Group C as compared to Group R (P<0.001). There was no significant difference in mean onset time for sensory and motor blockade, the hemodynamic parameters (pulse rate, diastolic and systolic blood pressure)during and after surgery, sedation score post operatively in either groups (P>0.05).

Conclusions: Clonidine 100µg added to 0.5% ropivacaine for supraclavicular brachial plexus block, does not shorten the onset of sensory and motor blockade but the combination produced prolonged sensory and motor blockade, improved and prolonged duration of analgesia, thereby decreasing the need for systemic analgesics without any hemodynamic changes.


Supraclavicular brachial plexus block, Ropivacaine, Clonidine, Sensory and motor block

Full Text:



Damien MB, Colin MJL, Vincent CWS. Novel analgesic adjuvants for brachial plexus block: A systemic review. Anesth Analg. 2000;90:1122-8.

Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anaesthesiol Scand. 1988;32:571-8.

Madhusudhana R, Kumar K, Kumar R, Potli S, Kapil M. Supraclavicular brachial plexus block with 0.75% ropivacaine and with additives tramadol, fentanyl-a comparative pilot study. Int J Biol Med Res. 2011;2:1061-3.

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.

Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011;55:104-10.

Selander D, Sjovall J, Waldenlind L. Accidental i.v. injections of ropivacaine: Clinical experience of six cases. RegAnaesth. 1997;22:70.

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. Anesthesiology. 2008;109:502-11.

Butterworth JF Vth, Strichartz GR. The alpha 2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers. AnesthAnalg. 1993;76:295-301.

ElSaied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anaesth. 2000;47(10);962-7.

Iohom G, Machmachi A, Diarra DP, Khantouf M, Boileau S, Dap F, etal. The effects of clonidine added to mepivacaine for paronychia surgery under axillary brachial plexus block. Anesth Analg. 2005;100:1079-83.

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):74-7.

Casati A, MagistrisL, Fanelli G, Beccaria P, Capplleri G, Aldegheri G, et al. Small-dose Clonidine prolongs postoperative analgesia after sciatic-femoral nerve block with 0.75% ropivacaine for foot surgery. AnesthAnalg. 2000;91:388-92.

Eledjam JJ, Viel EJ, Charavel P, Cailar J. Brachial plexus block with bupivacaine: effect of added alpha adrenergic agonist: Comparison between clonidine and epinephrine. Can J Anaesth. 1991;38(7):870-87.

Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of Clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg. 1996;83:1046-50.