A COMPARATIVE EVALUATION OF DEXEMEDETOMIDINE AND HYALURONIDASE USED AS ADJUVANTS TO LOCAL ANAESTHETICS FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Uditi Parmar; Rajni Thakur

Volume : VIII, Issue : IX, September - 2019

A COMPARATIVE EVALUATION OF DEXEMEDETOMIDINE AND HYALURONIDASE USED AS ADJUVANTS TO LOCAL ANAESTHETICS FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Uditi Parmar, Rajni Thakur

Abstract :

Background: Dexmedetomidine is a new alpha 2 agonist approved by FDA in 1999.Low plasma concentration results in analgesia ,sympatholysis and mild sedation without any respiratory depression. Perineural Dexmedetomidine causes augmentation of Local Anesthetic effect without causing nerve damage. Hyaluronidase has temporary reversible depolymerising action on polysaccharide hyaluronic acid which is a important component of intercellular matri AIM: PRIMARY OBJECTIVES: 1) To Evaluate the effect of addition of Dexmedetomidine and hyaluronidase to local anesthetic mixture on the pattern of sensory and motor block: Onset of Sensory and Motor block, Peak effect , duration of blockade and on duration of perioperative analgesia. 2) To evaluate and compare the hemodynamic parameters and sedation score in the two groups respectively. SECONDARY OJECTIVES: 1)To study the side effects and complications related to dexmedetomidine and hyaluronidase if any. Material and Method: It was a randomized, prospective, double blinded, comparative hospital based study at Department of Anaesthesiology, Gandhi Medical College, Bhopal. 40 ASA Grade I-II patients, age ranging from 20-40 years of either sex, scheduled for upper limb orthopaedic surgeries were randomly allocated into two groups of 20 patients each:  Group D-inj Bupivacaine(0.5%)1mg/kg+inj lignocaine(2%)3mg/kg+inj dexem (50micrograms)diluted upto 20ml.  Group H-inj Bupivacaine(0.5%)1mg/kg+inj lignocaine(2%)3mg/kg+inj hyaluronic acid 3000IU diluted upto 20ml. Results: There was significant decrease in time to each the sensory and motor block in group D as compared to group H with prolonged duration of sensory and motor block and reduction in post operative analgesic requirement in group D as compared to group H(P< 0.05) which shows that dexmedetomidine (50mcg) was effective as adjuvant to local anesthetics in early onset and prolonged duration of sensory and motor block. The duration of analgesia was significantly higher in the patients belonging to the Group D. Likewise, the average number of rescue analgesic doses received by Group H patients were more compared to patients in Group D. Conclusion: From our study we conclude that Dexmedetomidine 50 mcg is significantly superior to Hyaluronidase 3000IU as adjuvant to local anesthetics for supraclavicular achial plexus block.in patients undergoing upper limb orthopaedic surgeries.