Comparative Evaluation of Perineural Versus Intravenous Dexmedetomidine as an Adjuvant to Ropivacaine for Interscalene Brachial Plexus Block in Shoulder Joint & Lateral Clavicular Surgeries : A Randomised Control Trial

Abstract

Background & Aims: Upper extremity regional anesthesia is the mainstay of an anesthesiologist’s armamentarium. The aim of this study was to evaluate the analgesic efficacy of 50mcg perineural dexmedetomidine versus 50mcg of intravenous dexmedetomidine when given along with USG guided interscalene block using 15 ml of 0.75% ropivacaine and superficial cervical plexus block using 10 ml of 0.5% ropivacaine in patients undergoing shoulder joint and lateral clavicular surgeries.
Materials & Methods: This randomized controlled clinical study included 105 patients of ASA group I & II divided into three groups as Group R received 14.5 ml of 0.75% ropivacaine with 0.5ml normal saline as placebo, Group RDp received 14.5 ml of 0.75% ropivacaine with 50mcg (0.5ml) of perineural dexmedetomidine and Group RDi received 14.5 ml of 0.75% ropivacaine with 0.5ml normal saline with 50mcg (0.5ml) of intravenous dexmedetomidine. In addition, each group was given superficial cervical plexus block with 10 ml of 0.5% ropivacaine.
Results: The duration of analgesia was significantly prolonged in group RDp (704.57+272.90 mins) than group RDi (586.86+283.67 mins) & group R (335.71+35.17 mins) which was statistically significant. No significant adverse effects were noted.
Conclusion: The administration of adjuvant 50 mcg dexmedetomidine via perineural or intravenous route along with 0.75% ropivacaine for interscalene brachial plexus block significantly enhanced the onset of motor and sensory blockade as well as the duration of analgesia without any significant side effects and better patient satisfaction than patients receiving plain ropivacaine.