The investigators want to compare the effectiveness of dexamethasone and dexmedetomidine as an adjuvant to 0.5% ropivacaine for supraclavicular brachial plexus block on the onset of block and duration of analgesia, so that the investigators can choose the better adjuvant for the investigators routine practice of regional anesthesia.
Ropivacaine is a newer local anesthetic which is structurally related to bupivacaine, but has fewer side effects. It is more cardio stable than bupivacaine, but the onset of action is delayed and the duration of action is shorter than bupivacaine making its use during regional anesthesia less preferable to many anesthesiologists. Steroids like dexamethasone, or alpha-2 agonists like dexmedetomidine are being studied as adjuvants to ropivacaine for brachial plexus block to improve its anesthetic properties and have shown favorable outcome in terms of shortening the onset of block and prolonging the duration of action. But no study has been done to compare their effects. So in this study the investigators want to compare the effectiveness of dexamethasone and dexmedetomidine as an adjuvant to 0.5% ropivacaine for supraclavicular brachial plexus block on the onset of block and duration of analgesia, so that the investigators can choose the better adjuvant for the investigators routine practice of regional anesthesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
TRIPLE
Enrollment
120
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 1 ml normal saline
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 4mg (1ml) dexamethasone
Supraclavicular brachial plexus block will be given with 0.5% ropivacaine with 50 mcg (1ml) dexmedetomidine
B. P. Koirala Institute of Health Sciences
Dharān, Koshi, Nepal
Onset of sensory block
Sensory block in the territories of median nerve (palmar surface of index finger), ulnar nerve (palmar surface of little finger), radial nerve (dorsal surface of first web space/ thumb) and musculocutaneous nerve (lateral side of volar surface of forearm) will be assessed by pinprick test using a 3-point scale: 0 - normal sensation, 1. \- loss of sensation of pinprick (analgesia), 2. \- loss of sensation of touch (anaesthesia). Complete sensory block will be defined as grade 2 sensory block in 3 or more nerve territories.
Time frame: every 3 minutes until 45 minutes after injection of drug
Onset of motor block
Motor block will be evaluated by thumb flexion/ opposition (median nerve), thumb extension (radial nerve), finger abduction (ulnar nerve) and elbow flexion with forearm in full supination (musculocutaneous nerve) on a 3-point scale for motor function: 0 - normal motor function, 1. \- reduced motor strength but able to move, 2. \- complete motor block. Complete motor block will be defined as grade 2 motor block in 3 or more nerve territories.
Time frame: every 3 minutes until 45 minutes after injection of drug
Duration of analgesia
Time frame: Up to 24 hours after onset of block
Duration of sensory block
time from onset of sensory block to complete recovery of anaesthesia on all nerves.
Time frame: Up to 24 hours after onset of block
Duration of motor block
time from onset of motor block to the recovery of complete motor function of the hand and forearm
Time frame: Up to 24 hours after onset of block
Incidence of side effects of drugs
Side effects like bradycardia, tachycardia, hypotension, sedation, neurological deficit will be evaluated
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Time frame: Forty-eight hours following the injection of local anesthetics