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, 66 (4), 283-9

Comparison of Dexmedetomidine and Epinephrine as an Adjuvant to 1% Mepivacaine in Brachial Plexus Block

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Comparison of Dexmedetomidine and Epinephrine as an Adjuvant to 1% Mepivacaine in Brachial Plexus Block

Jang-Ho Song et al. Korean J Anesthesiol.

Abstract

Background: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block.

Methods: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 µg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 µg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index.

Results: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E.

Conclusions: Perineural 1 µg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 µg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.

Keywords: Brachial plexus; Dexmedetomidine; Epinephrine.

Figures

Fig. 1
Fig. 1
The mean arterial pressure (MAP) for the three groups in consecutive periods. There are no significant differences between the groups at each time. *P < 0.05 compared to baseline value in group C. P < 0.05 campared to baseline value in group E. P < 0.05 compared to baseline value in group D. Values are expressed as the mean ± SD. B: baseline, I: just after brachial plexus block, min: minutes, Group C: control group, Group E: epinephrine group, Group D: Dexmedetomidine group.
Fig. 2
Fig. 2
The heart rate (HR) for the three groups in consecutive periods. Heart rate was significantly lower in group D compared to group E in 20 minutes, 30 minutes, 35 minutes and 40 minutes after drug injection. And in group D, heart rate was significantly lower compared to group C in 40 mimutes after drug injection. Values are expressed as mean ± SD. *P < 0.05 compared to group E in each time. P < 0.05 compared to group C. P < 0.05 compared to baseline value in each groups. B: baseline, I: just after brachial plexus block, min: minutes, bpm: beats per minutes, Group C: control group, Group E: epinephrine group, Group D: Dexmedetomidine group.
Fig. 3
Fig. 3
The bispectral index (BIS) score for the three groups in consecutive periods. BIS was significantly lower in group D compared to group C in 15 minutes, 20 minutes, 25 minutes, 30 minutes, 35 minutes, 40 minutes and 60 minutes after drug injection. And in group D, BIS was significantly lower compared to group E in 15 mimutes, 35 minutes and 60 minutes after drug injection. Values are expressed as mean ± SD. *P < 0.05 compared to group E in each time. P < 0.05 compared to group C. P < 0.05 compared to baseline value in each groups. B: baseline, I: just after brachial plexus block, min: minutes, Group C: control group, Group E: epinephrine group, Group D: Dexmedetomidine group.

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