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EVALUATION OF DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BLOCK FOR PATIENTS UNDERGOING UPPER LIMB PLASTIC SURGICAL PROCEDURES.

Background: Different adjuvants are used with local anesthetics to improve quality of peripheral nerve blocks. The aim of our study was to evaluate the effect of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block with respect to onset of sensory and motor blockade and duration of blockade and analgesia. Patients and Methods: Sixty patients of ASA grade I and II, aged 18-55 years of either sex scheduled for upper limb plastic surgical procedures under supraclavicular brachial plexus block were randomly divided into two equal groups. Patients in control group R (n = 30) received 29 ml of 0.5% and analgesic requirements. In our study we evaluated the effect of addition of dexmedetomidine (50mcg) to ropivacaine in supraclavicular block. Results of our study infer that onset of sensory & motor blockade were rapid with adding dexmedetomidine to ropivacaine. Our observations are in accordance with the findings of Esmaoglu A et al. [16] who evaluated the effect of dexmedetomidine added to levobupivacaine for brachial plexus block and observed that the onset of sensory & motor blockade was shorter (9.03±1.15 min ,9.50 ±1.04 min respectively ) in dexmedetomidine group than (10.46±1.30 min,11.10±1.24min respectively) in control Group. Similar findings were observed by Ammar and Mahmoud. [17] Our findings revealed that duration of sensory & motor blockade prolonged in group RD as compared to group R. This may be because peripheral alpha2 agonist produces analgesia by reducing the release of norepinephrine leading to alpha2 receptor independent inhibitory effects on nerve fiber action potential. Centrally, alpha2 agonist produces sedation and analgesia by abolition of Substance P release in nociceptive pathway at the level of dorsal horn and activation of alpha2 receptor in locus ceruleus. [18] Our observations were in accordance with the findings of Swami SS et al. [19] they used alpha2 agonist with local anaesthetic to extend the duration of peripheral nerve blocks. Ammar and Mahmoud [17] observed that adding dexmedetomidine (0.75mcg/kg) to bupivacaine (0.33 %) significantly prolonged the duration of sensory & motor blockade as compared to bupivacaine alone. compared observations in the findings Kathuria