Comparative clinical study between dexmedetomidine and fentanyl as adjuvants to bupivacaine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries: a randomized study

Abstract

Background The use of regional nerve block techniques is shown to successfully minimize the response to stress in patients. In addition, the administration of small amounts of anesthetic medicines is consistently advantageous for individuals with diverse comorbidities. The objective of this work was to evaluate the motor and sensory properties of ultrasound (US)-guided supraclavicular brachial plexus block (SCBPB) utilizing bupivacaine 0.5% alone or in combination with dexmedetomidine or fentanyl among individuals having elective upper limb surgery. Patients and methods This prospective, randomized, double-blinded study was performed on 150 individuals with the American Society of Anesthesiologists class I and II, who underwent elective upper limb surgeries utilizing US-guided SCBPB. Participants were divided into three equal groups at random; group D (dexmedetomidine group) was administered 30 ml of bupivacaine 0.5% plus 100 μg of dexmedetomidine (2 ml); group F (fentanyl group) was administered 30 ml of bupivacaine 0.5% plus 100 μg of fentanyl (2 ml); and group C (control group) was administered 30 ml of bupivacaine 0.5% plus 2 ml normal saline 0.9%. All patients received US-guided SCBPB with 32 ml of the local anesthetic mixture. Results The length of motor and sensory blockade was substantially longer in group D compared with group F and group C, with significantly faster onset and prolonged duration in group F compared with group C. The visual analog scale at 4 h was substantially greater in group C compared with groups D and F, but at 6, 8, and 24 h it was substantially higher in both groups F and C compared with group D. Modified Ramsay score 15, 30, and 60 min after injection was substantially greater in group D and group F contrasted to group C. Time for first postoperative call for analgesia was substantially longer in group D contrasted to group F and group C and was substantially longer in group F contrasted to group C. Total analgesic consumption was substantially decreased in group D compared with groups F and C. Conclusions The addition of 100 μg of dexmedetomidine in SCBPB was more efficient in achieving faster onset and prolongation of motor and sensory duration in addition to ensuring sufficient intraoperative analgesic provision.