Comparison between Effects of Buprenorphine and Clonidine added to Bupivacaine in Supraclavicular Brachial Plexus Block

Nisha Saral, J (2013) Comparison between Effects of Buprenorphine and Clonidine added to Bupivacaine in Supraclavicular Brachial Plexus Block. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION: There are various techniques to anaesthetise a patient. It is really a divine venture to alleviate the pain. Regional techniques are now a days becoming more and more popular because it has its own advantages of providing anaesthesia and pain relief and relaxation required for the surgery pertaining to the area required only without unnecessarily blocking the other sites and avoiding unnecessary complications which can be better avoided just by reducing the poly pharmacy as in general anaesthesia which is not always needed or better to be said it is unnecessary for all the cases. The generalized thought of general anaesthesia for any surgery has been totally out dated now a days. Thanks to the regional anaesthesia as such because it is feasible many a time and has won very good patient compliance also. Among the regional techniques we are going to focus mainly on the regional anaesthesia for the upper limb that is the brachial plexus blockade. There are various available approaches and techniques in brachial plexus blockade. Among them this study concentrates on the supra clavicular technique. In the supra clavicular technique a huge number of studies have been done at various angles. Many studies have concentrated on the local anaesthetics and its varying concentrations used and their respective effects upon the patients. ADJUVANTS: These Are Nothing but the Drugs Which are Added To Local Anaesthetics In Order To • Hasten the Onset of Blockade Or • To Prolong the Duration of Block Or • To Improve The Quality of Blockade. Humpty number of studies have been conducted upon using various and different classes of drugs as adjuvants in brachial plexus block. To enumerate upon the drugs : • Epinephrine, • Sodium bicarbonate, • Clonidine, • Dexamethasone, • Tramadol, • Dexmedetomidine, • Butorphanol, • Buprenorphine, • Fentanyl, • Alfentanyl. And so on. Each and every drug behaved in a different fashion. But among all those studies there have not been any study focused on comparison between buprenorphine and clonidine. Hence this special study is focused to contrast the effects of buprenorphine and clonidine as analgesic adjuvants to bupivacaine in supraclavicular brachial plexus blockade. AIM AND OBJECTIVES: AIM OF THE STUDY: To compare the effectiveness of adding buprenorphine and clonidine as adjuvants to 0.3% bupivacaine in supraclavicular brachial plexus blockade. OBJECTIVES: To evaluate, 1. The onset time for sensory and motor blockade, 2. The time for complete motor and sensory blockade, 3. The total duration of sensory and motor blockade, 4. Adverse effects. MATERIALS AND THE METHODS Study Design: Prospective randomized controlled observer blinded study. POPULATION: 60 patients Inclusion Criteria: • ASA I, II • age 20 to 50 • unilateral upper limb orthopaedic surgeries • both sexes Blinding: It is mainly an observer blinded study. Sample Size: Group Allocation : • Group A (n = 20) – patients receiving 30 ml of 0.3% bupivacaine with 1 ml of normal saline in supraclavicular block as CONTROL GROUP • Group B (n = 20) – patients receiving 30 ml of 0.3% bupivacaine with 300 mcg buprenorphine [ 1 ml ] in supraclavicular block as BUPRENORPHINE GROUP Group C ( n= 20) - patients receiving 30 ml of 0.3% bupivacaine with 150 mcg clonidine [ 1 ml ] in supraclavicular block as CLONIDINE GROUP Exclusion Criteria: • Suspected coagulopathy, • Infection at the site of block, • Age less than 20 and more than 50, • Coexisting diseases like hypertension, diabetes, seizure disorder, liver disease, renal disease, CAHD, • Patient refusal, • Allergy to local anaesthetics and study drugs, • Pregnant women, • ASA III , IV, • Bilateral upper limb procedures, • Pneumothorax even on any one side, • Pulmonary pathology. SUMMARY: Onset time for sensory block: It is shorter in buprenorphine group than the other groups. Onset time for motor block: It is similar in the control and buprenorphine group but it is longer in clonidine group than the other groups. Time for complete sensory block: This came out as similar in all the groups. Time for complete motor block: It is found to be longer in clonidine group than the other 2 groups which have similar TCMB. Total duration of motor block: It is almost similar in all the groups. Total duration of sensory block: Buprenorphine group has the longest duration of sensory block then comes the clonidine group and then the control group. CONCLUSION: We conclude from this randomized controlled study that buprenorphine • hastens the onset of sensory block, • significantly prolongs the duration of analgesia compared to clonidine • without any significant effect on onset of motor block and duration of motor block and • without any significant adverse effects. Hence it is clear from this study that buprenorphine is a better adjuvant than clonidine in supraclavicular brachial plexus block.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Buprenorphine ; Clonidine ; Bupivacaine ; Supraclavicular Brachial Plexus Block ; Comparison study.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:56
Last Modified: 01 May 2018 07:42
URI: http://repository-tnmgrmu.ac.in/id/eprint/7348

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