Uditi parmar, Rajni Thakur


Background: Dexmedetomidine is a new alpha 2 agonist approved by FDA in 1999.Low plasma
concentration results in analgesia ,sympatholysis and mild sedation without any respiratory
depression. Perineural Dexmedetomidine causes augmentation of Local Anesthetic effect without causing nerve damage.
Hyaluronidase has temporary reversible depolymerising action on polysaccharide hyaluronic acid which is a important
component of intercellular matri
1) To Evaluate the effect of addition of Dexmedetomidine and hyaluronidase to local anesthetic mixture on the pattern of
sensory and motor block: Onset of Sensory and Motor block, Peak effect , duration of blockade and on duration of
perioperative analgesia.
2) To evaluate and compare the hemodynamic parameters and sedation score in the two groups respectively.
1)To study the side effects and complications related to dexmedetomidine and hyaluronidase if any.
Material and Method: It was a randomized, prospective, double blinded, comparative hospital based study at Department of
Anaesthesiology, Gandhi Medical College, Bhopal. 40 ASA Grade I-II patients, age ranging from 20-40 years of either sex,
scheduled for upper limb orthopaedic surgeries were randomly allocated into two groups of 20 patients each:
Ÿ Group D-inj Bupivacaine(0.5%)1mg/kg+inj lignocaine(2%)3mg/kg+inj dexem (50micrograms)diluted upto 20ml.
Ÿ Group H-inj Bupivacaine(0.5%)1mg/kg+inj lignocaine(2%)3mg/kg+inj hyaluronic acid 3000IU diluted upto 20ml.
Results: There was signicant decrease in time to each the sensory and motor block in group D as compared to group H with
prolonged duration of sensory and motor block and reduction in post operative analgesic requirement in group D as compared
to group H(P< 0.05) which shows that dexmedetomidine (50mcg) was effective as adjuvant to local anesthetics in early onset
and prolonged duration of sensory and motor block.
The duration of analgesia was signicantly higher in the patients belonging to the Group D. Likewise, the average number of
rescue analgesic doses received by Group H patients were more compared to patients in Group D.
Conclusion: From our study we conclude that Dexmedetomidine 50 mcg is signicantly superior to Hyaluronidase 3000IU as
adjuvant to local anesthetics for supraclavicular brachial plexus block.in patients undergoing upper limb orthopaedic


Dexmedetomidine, Hyaluronidase , supraclavicular brachial block.

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Virtanen R, Savola JM, Saano V, Nyman L. Characterisation of selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharmacol 1988;150:9-14

Shehabi Y, Ruettimann U, Adamson H, Innes R, Ickeringill M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: Sedative and cardiovascular effects. Intensive Care Med 2004;30:2188-96.

Yazbek-Karam VG, Aouad MA. Perioperative uses of dexmedetomidine. Middle East J Anesthesiol 2006;18:1043-58.

Nathan N, Benrhaiem M, Lotfi H, et al. The role of hyaluronidase on lidocaine and bupivacaine pharmacokinetics after peribulbar blockade. Anesthesia and Analgesia 1996; 82: 1060–4.

Lewis-Smith PA. Adjunctive use of hyaluronidase in local anaesthesia. British Journal of Plastic Surgery 1986; 39: 554–8.

Dunn AL, Heavner JE, Racz G, Day M. Hyaluronidase: a review of approved formulations, indications and off-label use in chronic pain management. Expert Opinion on Biological Therapy 2010; 10: 127–31.

Yoshitomi, Tatsushi DDS*; Kohjitani, Atsushi DDS, PhD†; Maeda, Shigeru DDS, PhD*; Higuchi, Hitoshi DDS, PhD*; Shimada, Masahiko DDS, PhD‡; Miyawaki, Takuya DDS, PhD Dexmedetomidine enhances the local Anesthetic action of lignocaine via an ∝2A adrenoreceptor. July 2008 - Volume 107 - Issue 1 - p 96-101

Masuki S, Dinenno FA, Joyner MJ, Eisenarch JH. Selective alpha2-adrenergic properties of dexmedetomidine over clonidine in the human forearm. J Appl Physiol. 2005;99:587–92.

Aliye Esmaoglu;Fusun Yegenoglu;Aynur Akin;Cemil Turk et al dexmedetomidine added to levobupicaine prolongs axillary plexus block. Anesthesia & Analgesia. 111(6):1548–1551, DECEMBER 2010.

Moore DC (1950) An evaluation of hyaluronidase in local and nerve block analgesia: a review of 519 cases. Anesthesiology 11: 470-484.

Eckenhoff JE, Kirby CK (1951) The use of hyaluronidase in regional nerve blocks. Anesthesiology 12: 27-32.

Keeler JF, Simpson KH, Ellis FR, Kay SP. Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block. Br J Anaesth 1992; 68:68–71.

Kim TW, Lee JH, Yoon KB, Yoon DM. Allergic reactions to hyaluronidase in pain management − a report of three cases. Korean J Anesthesiol 2011; 60:57–59.


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