ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING CLONIDINE VERSUS DEXMEDETOMIDINE AS ADJUVANTS TO ROPIVACAINE FOR POST-OPERATIVE ANALGESIA IN UPPER LIMB SURGERIES

Abstract

Introduction: Brachial plexus blocks are widely used for upper limb surgeries, with various adjuvants being employed to enhance block quality and prolong postop analgesia. This study compared the efficacy of clonidine versus dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper limb surgeries. Methods: This prospective, randomized, double-blind study included 106 ASA I-II patients aged 18-60 years undergoing upper limb surgeries. Patients were randomly allocated into two groups (n=53 each): Group A received 30 ml of 0.5% ropivacaine with clonidine 2 μg/kg, and Group B received 30 ml of 0.5% ropivacaine with dexmedetomidine 1 μg/kg. Primary outcomes measured included onset and duration of sensory and motor blockade, time to first rescue analgesia, pain scores, and adverse effects. Results: Demographic profiles were comparable between groups. The dexmedetomidine group demonstrated significantly faster onset of sensory block (6.95±1.47 vs 9.28±1.80 min, p<0.001) and motor block (8.70±2.00 vs 12.08±2.40 min, p<0.001). Block duration was also superior with dexmedetomidine for both sensory (668.26±41.65 vs 551.81±43.93 min, p<0.001) and motor components (595.06±42.37 vs 497.94±46.61 min, p<0.001). The dexmedetomidine group exhibited prolonged time to first rescue analgesia (716.45±76.88 vs 579.15±57.30 min, p<0.001), lower pain scores at rescue (3.28±1.10 vs 4.51±1.09, p<0.001), and reduced analgesic requirements (1.92±0.85 vs 3.51±1.15 doses, p<0.001). Hemodynamic parameters remained stable in both groups, with no significant differences in the incidence of adverse effects. Conclusion: Dexmedetomidine is superior to clonidine as an adjuvant to ropivacaine in xxi ultrasound-guided supraclavicular brachial plexus block, providing faster onset, prolonged duration of blockade, extended postoperative analgesia, and a favourable safety profile for patients undergoing upper limb surgeries