Clonidine as an adjuvant to local anesthetic in supraclavicular brachial plexus block: a randomized, double blinded placebo controlled study

Authors

  • Preeti Rustagi Department of Anaesthesiology, Lokmanya Tilak municipal medical College, Mumbai, India
  • Geeta A. Patkar Department of Anaesthesiology, Lokmanya Tilak municipal medical College, Mumbai, India
  • Yogesh Malpani Department of Anaesthesiology, Lokmanya Tilak municipal medical College, Mumbai, India
  • Bharati A. Tendolkar Department of Anaesthesiology, Lokmanya Tilak municipal medical College, Mumbai, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20162849

Keywords:

Clonidine, Local anesthetic, Supraclavicular brachial plexus block, Sensory and motor block

Abstract

Background: Many drugs have been studied as adjuvants to local anesthetic agents with the aim of improving the quality of anesthesia and to provide profound analgesia. Clonidine has also been used as an adjunct to local anesthetic agents in various regional techniques. The studies regarding clonidine in brachial plexus block have given mixed results. Aim was to determine whether addition of clonidine to the local anesthetic solution for brachial plexus block by supraclavicular approach, prolongs sensory and motor blockade and improves postoperative analgesia. Also to observe side effects if any.

Methods: 60 patients aged 18-60 years, were randomly allocated into two groups. Group A received 2 µg / kg of Clonidine diluted to 1 ml with saline and group B received 1 ml of saline added to bupivacaine (10 ml 0.5%) and lignocaine (20 ml 2 %) solution, in the supraclavicular block. The onset and duration of sensory and motor block was compared along with the duration of analgesia, sedation in both the groups. Patients’ pulse rate, blood pressure, saturation was also recorded.

Results: Addition of clonidine had no effect on the onset of the block, but was found to increase the duration of sensory and motor block along with the increase in the duration of analgesia. Visual analogue score for pain was significantly lower in the group receiving clonidine.

Conclusions: Clonidine 2 µg / kg added to 10 ml of 0.5 % Bupivacaine + 20 ml of 2% lignocaine with adrenaline (1:200000) is a good option for improving the quality and duration of supraclavicular brachial plexus block.

References

Kaabachi O, Ouezini R, Koubaa W, Ghrab B, Zargouni A, Ben Abdelaziz A. Tramadol as an adjuvant to lidocaine for axillary brachial plexus block. Anesth Analg. 2007;23:187-9.

Karakaya D, Büyükgöz F, Bariş S, Güldoğuş F, Tür A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med. 2001;26:434-8.

Casati A, Magistris L, Beccaria P, Cappelleri G, Aldegheri G, Fanelli G. Improving postoperative analgesia after axillary brachial plexus anesthesia with 0.75% ropivacaine. A double blind evaluation of adding clonidine. Minerva Anestesiol 2001;67:407-12.

Erlacher W, Schuschnig C, Koinig H, Marhofer P, Melischek M, Mayer N, et al. Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block. Can J Anaesth. 2001;48:522-5.

Iskandar H, Guillaume E, Dixmérias F, Binje B, Rakotondriamihary S, Thiebaut R, et al. The enhancement of sensory blockade by clonidine selectively added to mepivacaine after mid humeral block. Anesth Analg. 2001;93:771-5.

Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesth Analg 2001;92:199-204.

Duma A, Urbanek B, Sitzwohl C, Kreiger A, Zimpfer M, Kapral S. Clonidine as an adjuvant to local anaesthetic axillary brachial plexus block: a randomized, controlled study. Br J Anaesth. 2005;94:112-6.

Erlacher W, Schuschnig C, Orlicek F, Marhofer P, Koinig H, Kapral S. The effects of clonidine on ropivacaine 0.75% in axillary perivascular brachial plexus block. Acta Anaesthesiol Scand. 2000;44:53-7.

Pinto Neto W, Issy AM, Sakata RK. A comparative study between bupivacaine and clonidine associated with bupivacaine in cervical plexus block for carotid endarterectomy. Rev Bras Anestesiol. 2009;59:387-95.

Nishikawa T, Dohi S. Clinical evaluation of clonidine added to lignocaine solution for epidural anesthesia. Anesthesoilogy. 1990;73:853-9.

Singelyn FJ, Dangoisse M, Bartholomee S, Gouverneur JM. Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Reg Anesth. 1992;17:148-50.

Ramsay MA, Savage TM, Simpson BR, Godwin R. Controlled sedation with alphaxolone-alphadolone. Br Med J. 1974;2:656-9.

El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009;103:268-74.

Bhatnagar S, Mishra S, Madhurima S, Gurjar M, Mondal AS. Clonidine as an analgesic adjuvant to continuous paravertebral bupivacaine for post-thoracotomy pain. Anaesth Intensive Care. 2006;34:586-91.

Gabriel JS, Gordin V. Alpha 2 agonists in regional anesthesia and analgesia. Curr Opin Anaesthesiol 2001;14:751-3.

Eledjam JJ, Deschodt J, Viel EJ. Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine. Can J Anesthesia. 1991;38(7):870-5.

Casati A, Magistris L, Fanelli G, Small-dose clonidine prolongs postoperative analgesia after sciatic-femoral nerve block with 0.75% ropivacaine for foot surgery. Anesth Analg. 2000;91(2):388-92.

Singh S, Aggarwal A. A randomized controlled dou- ble-blinded prospective study of the efficacy of cloni-dine 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.

Chakraborty S, Chakrabarti J. Das Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trials. Indian J Pharmacol. 2010;42(2):74-7.

YaDeau JT, LaSala VR, Paroli L. Clonidine and analgesic duration after popliteal fossa nerve blockade: randomized, double-blind, placebo-controlled study. Anesth Analg. 2008;106(6):1916-20

Bernard JM, Macarie P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiol. 1997;87:277-84.

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Published

2017-01-10

How to Cite

Rustagi, P., Patkar, G. A., Malpani, Y., & Tendolkar, B. A. (2017). Clonidine as an adjuvant to local anesthetic in supraclavicular brachial plexus block: a randomized, double blinded placebo controlled study. International Journal of Basic & Clinical Pharmacology, 5(5), 1892–1897. https://doi.org/10.18203/2319-2003.ijbcp20162849

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Original Research Articles