Dr. Ashish Gupta, Dr. Gopal Singh Maravi


Background: Over decades various local anaesthetic agents have been used for utility of supraclavicular brachial plexus block. Levobupivacaine, an excellent local anaesthetic as well as Ropivacaine, a long-acting local anaesthetic. Methodology: Patients were randomly allocated into two study groups (30 patients each) of all patients received 30 ml of 0.5% injection Levobupivacaine and injection Dexmedetomidine 1µg/kg (LD) while in other group all patients received 30 ml of 0.5% injection Ropivacaine and injection Dexmedetomidine 1µg/kg (RD). Results: Time to onset and duration of both sensory and motor block was comparable in two groups (P>0.05). Though mean duration of analgesia was significantly (p<0.005) more for Group-LD when compared to Group-RD. The difference in mean score of VAS in both groups was significantly better for LD-Group at 12, 14 and 16 hour post-operative period (P<0.05) though initially it was comparable.The consumption of Diclofenac as rescue analgesia was significantly higher in Group-RD as compared to Group-LD. Conclusion: Addition of dexmedetomidine along with levobupivacaine for supraclavicular brachialplexus block enhances the duration of postoperative analgesia as well diminished requirement for rescue analgesia in postoperative period compaired to along with ropivacaine.


Levobupivacaine versus ropivacaine, Dexmedetomidine, Analgesia.

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Robinson DH1, Toledo AH. Historical development of modern anesthesia. J Invest Surg. 2012 Jun;25(3):141-9.

Liu SS. A comparison of regional versus general anaesthesia for ambulatory anaesthesia: a metaanalysis of randomized controlled trials. Anaesth Analg 2005;10:1634-42.

Liu SS. The effect of Analgesic technique on Post-operative patient reported outcomes including analgesia; a systematic review. Anaesth Analg 2007; 105:789-808.

McCartney CJ, Brull R, Chan VW et al. Early but no long term benefit of regional compared with general anaesthesia for ambulatory hand surgery. Anaesthesiology 2004;10:461-7.

Hoffmann J, Westendroff C, Reiner S. Evaluation of dental injury following endotracheal intubation using the perioral technique. Dent trauma tol. 2005 oct;21(5):263-8

Aitkenhead AR. Injuries associated with anaesthesia. a global perspective. British journal of Anaesthesia 2005:95(1):95-109.

Jacques E. Chelly . Peripheral Nerve Blocks: a color atlas.2nd Edition. 2004 Lippincot Williams &wilkins,Chapter 1.

Neal JM, Geranchu JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD et al. Upper extremity regional anaesthesia. Reg Anaesth pain Med 2009 Mar- Apr:34(2);134-170.

Livingston EM, Werthein H. Brachial plexus block: its clinical application. Anaesth Analog J 1927 Jun;6(3) :149-156.

Fischer HBJ. Brachial plexus Anaesthesia In. Principles and practice of regional Anaesthesia; wildsmith JAW, Armitagfe EN, McClure JH, editors, 3rd edition. London: Churchill Livingstone, 2003;193-204.

Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on Neuraxial and peripheral nerve block: a systematic review and meta analysis. Br. J Anaesth. 2013; 110; 915-25.

Robaux S, Blunt C et al. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves post operative analgesic dose dependency. Anaesth Analg. 2004;98:1172-7.

Antonucci S. Adjuvants in the axillary brachial plexus blockade. Comparision b/w clonidine, sufentanyl & tramadol. Minerva Anaesthesiol. 2001;67:23-7.

Geze S, Ulusoy H, Erturk E, Ckeiz B, Arduc C. Comparision of local anaesthetic mixture with tramadol or fentanyl for axillary plexus block in orthopaedic upper extremity surgery. Eur J. Gen Med. 2012;9:118-23.

Kanazi GE, Aouad MT, Jabbour K et al. Effect of low dose dexmedetomidine or clonidine as characteristics of bupivacaine spinal block. Acta Anaesth Scand; 2006; 50: 222-7.

Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr drug target. 2009;10:696-706.

Becchi C, Malyanm, Coppini R, Campolo M, Magherini M et al. Opioid free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study: Eur J Anaesth.2008;25(5):418-23.

Connolly C , Coventry D M , Wild smith J A, Double blind comparison of ropivacaine 7.5mg/ml with bupivacaine 5 mg/ml for sciatic nerve block. Br J Anaesth 2001;86:674-7.

Borghi B, Facchini F, Agnoletti V et al. Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: A prospective randomized, double blind comparison between levobupivacaine 0.25% and ropivacaine 0.25% or 0.4%. Eur J Anaesthesiol 2006;23:1005-9.

Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anaesthetics, ropivacaine and levobupivacaine. Acta Biomed 2008;79:92 105.

Buckenmaier CC 3rd, Bleckner LL. Anaesthetic agent for advanced regional anaesthesia : A north American prospective Drugs. 2005;65(6):745-59.

Sia AT, Goy RW, Lim Y et al. A comparison of median effective doses of intrathecal levobupivacaine and ropivacaine for labor analgesia. Anaesthesiology 2005;102:651-6.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with recemic bupivacaine for lower abdominal surgery. Anaesth Analg 2000;90:642-8.

Egashira T, Fukasaki M, Araki H et al. Comparative efficacy of levobupivacaine and ropiovacaine for epidural block in out patients with degenerative spinal disease. Pain physician 2014;17:525-9.

Perroti L, Cusato M, Ingelme P et al. A comparison of differences between the systemic pharmacokinetics of levobupivacaine and ropivacaine during continues epidural infusion: A prospective randomised multicenter double blind controlled trial. Anaesth Analg 2015;121:348-56.

Patki YS, Bengali R, Patil T. Efficacy of dexmedetomidine as an adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block for postoperative analgesia. International Journal of Science and Research (IJSR) 2015;4(1):2345-51.

Rashmi HD, Komla HK. Effect of dexmedetomidine as an adjuvant to 0.75% ropivacaine in interscalene brachial plexus block using a nerve stimulator: A prospective randomised double blind study. Anaesth Essay and Res .2017 Jan-Mar;11(1):134-139.

Kaygusuz K, Ozdemir I, Duger C, Gursoy S, Ozturk H; Kayacan U et al. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block. Curr Ther Res. 2012;73:103-11.

Nallam SR, Chiruvella S, Karanam S. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial. Indian J Anaesth. 2017;61:256–61.

Sudani C, Rao SM, Munta K. A comparative study of ropivacaine alone versus ropivacaine with dexmedetomidine in supraclavicular brachial plexus block. Anesthesiol Open J 2016;1:28-34.

Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. NJMR.2012;2(1):67-69.

Jun Z, Han W, Wen L et al. Effect of dexmedetomidine on brachial plexus block with ropivacaine and upper extremity ischemia-reperfusion (I/R) injury in patient undergoing upper extremity surgery. Zhonghua Ma Zui Xue Za Zhi. 2011;1:84-7.

Chinappa J, Shivanna S, Pujari V S, Anandaswamy TC. Efficacy of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block for upper limb surgeries. J Anaesthesiol. Clin Pharmacol. 2017 Jan-Mar;33(1):81-85.

McLeod GA, Columb MO. Moles,Weights and potencies: Freedom of expression percentage. Br J Anaesth.2005;95:110-1.

Casati A, Borghi B, Fanelli G, Cerchierini E, Santorsola R, Sassoli V et al. A double blinded, randomised comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anaesth analg.2002;94:987-90.

Casati A, Vinceguerra F, Santorsola R, Aldegheri G, Putzu M, Fanelli G. Sciatic nerve block with 0.5% levobupivacaine, 0.75% levobupivacaine or 0.75% ropivacaine. A double blind randomised comparison. Eur J Anaesthesiol.2005;2:452-6.

Fournier R, Faust A, Chassot O, Gamulin Z. Levobupivacaine 0.5% provides longer analgesia after sciatic nerve block using Labat approach than the same dose of ropivacaine in foot and ankle surgery. Anaesth Analg.2010;110:1486-9.

Casati A, Santorsola R, Aldegheri G, Ravasi F, Fanelli G, Berti M et al. Intraoperative epidural anaesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: A double blinded randomised comparison comparison of recemic bupivacaine and ropivacaine. J Clin Anaesth. 2003;15:126-31.

Singh AP, Mahindra M, Gupta R, Bajwa SJS. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: a novel anaesthetic approach. Anaesth Essays and researchers. 2016;10(3): 414-419.


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