A Comparative study of 0.25% Bupivacaine with Clonidine, Fentanyl and Midazolam as Adjuvants for Brachial Plexus Block

Suganthalakshmi, C (2010) A Comparative study of 0.25% Bupivacaine with Clonidine, Fentanyl and Midazolam as Adjuvants for Brachial Plexus Block. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Regional anaesthesia as the name implies is the blocking of peripheral nerve conduction in a reversible manner by using local anaesthetic agents thereby one region of the body is made insensitive to pain and is devoid of reflex response to surgical stimuli. The central nervous system is spared, so the patient is conscious during the surgical procedure. Regional anaesthesia offers many advantages over general anaesthesia for surgery on upper extremities particularly in emergency operations. Clonidine an α2 adrenergic agonist has been extensively studied as an adjunct to general and regional anaesthesia. It has been shown to produce this effect by activation of postsynaptic adrenergic receptors. Fentanyl an μ-receptor agoinst has also been used widely in intrathecal, extradural and peripheral nerve plexus blockade. Midazolam, a water soluble benzodiazepine, is known to produce antinociception and to enhance the effect of local anaesthesia when given epidurally or intrathecally. Midazolam produces this effect by its action on GABA – A receptors. The presence of GABA receptors in peripheral nerves is also demonstrated. This study is intented to determine and compare the effects of adding additives like clonidine, fentanyl and midazolam to bupivacaine in brachial plexus blockade by supraclavicular approach with regard to onset, and blockade duration of blockade along with its analgesic efficacy and quality of analgesia and sedation. AIM OF THE STUDY The aim of the present study is to evaluate the effects of addition of 1 mcg / kg of preservative free clonidine to the maximum of 75 mcg, 1 mcg / kg of preservative free fentanyl to the maximum of 50mcg and 50mcg / kg of preservative free midazolam to 30ml of 0.25%. Bupivacaine solution in supraclavicular brachial plexus block with regard to • Onset of blockade, • Duration of blockade, • Quality of analgesia, • Sedation, • Hemodynamic stability, • Complications if any. MATERIALS AND METHODOLOGY: 60 adult patients of both sexes in the age group of 20-60 years belonging to ASA I / II category and their weight ranging between 40-70 kgs posted for various types of upper limb surgeries at the Department of Orthopedics and Department of Plastic surgery Govt. KMCH formed the study group. This study was designed as a prospective randamized comparative study. After receiving the institutional ethical committee approval and informed consent, the patients were randomly allocated into 4 groups brachial plexus block with Nerve Stimulator was performed with supraclavicular block technique. GROUPS: 1. BC – 15 patients received 30ml of 0.25% Bupivacaine with 1mcg/kg of preservative free clonidine to the maximum of 75mcg. 2. BF – 15 patients received 30ml of 0.25% Bupivacaine with preservative free fentanyl 1 mcg /kg to the maximum of 50 mcg. 3. BM – 15 patients received 30ml of 0.25% Bupivacaine with preservative free midazolam 50 mcg/kg. 4. B – 15 patients received 30ml of 0.25% bupivacaine. Inclusion Criteria: 1. ASA I & II, 2. Age Group 20-60 years, 3. Weight 40 – 70 kgs, 4. Surgeries of the upper limb. Exclusion Criteria: 1. Patients refusal, 2. Coagulopathy, 3. Infection at Injection site. SUMMARY: 1. Onset and completion time for both sensory and motor blockade was quicker in the group I (Bupivacaine plus clonidine group) followed by group II (Bupivacaine plus fentanyl) and group III (Bupivacaine plus midazolam). 2. The mean duration of the sensory and motor blockade was significantly prolonged in group I (bupivacaine plus clonidine group). 3. Sedation was statistically significant in group III (Bupivacaine plus midazolam) in the intraoperative period. 4. Hemodynamic parameters was found to be altered much in group I (BC) than the other groups. 5. Patient's compliance and acceptance of the block is more with group I (BC) and group III (BM) followed by group II (BF) and group IV (B). 6. There was no complication due to addition of 1mcg/kg of clonidine to the maximum of 75 mcg and 1mcg/kg of fentantyl to the maximum of 50mcg and 50mcg/kg midazolam to bupivacaine. CONCLUSION: In conclusion, clonidine 1mcg/kg to a maximum of 75mcg added to 0.25% Bupivacaine solution for supraclavicular brachial plexus block, quickens the onset of sensory and motor blockade, prolongs the duration of sensory blockade, improves the quality of postoperative analgesia when compared to fentanyl and midazolam group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: 0.25% Bupivacaine ; Clonidine, Fentanyl ; Midazolam ; Adjuvants ; Brachial Plexus Block.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 01 May 2018 01:27
Last Modified: 01 May 2018 05:39
URI: http://repository-tnmgrmu.ac.in/id/eprint/7385

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