COMPARATIVE EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE VERSUS BUPIVACAINE ALONE IN PROLONGING POSTOPERATIVE ANALGESIA AND SEDATION FOLLOWING SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Abstract

Background: Pain experienced by patients after upper limb surgery affects the recovery of patients and increases costs. Supraclavicular brachial plexus block with bupivacaine increases the rate of pain relief after the surgery. But for very short time, so more opioids will use. It causes some side effects such as nausea and slow breathing. It may increase the time of pain relief. In various studies, there are different results on dose and benefits. This study checks if adding dexmedetomidine (1 mcg) to bupivacaine in a SCBPB works better than bupivacaine alone. We compared pain relief time, sedation, need for extra pain drugs, side effects, and patient satisfaction in two patient groups.

Methods: This comparative quantitative study included 60 ASA I, II, III patients aged 25 to 60 yrs scheduled for elective upper limb surgery under ultrasound-guided SCBPB. Patients were divided into two equal groups (n=30 per group). Group A received 0.125% bupivacaine with dexmedetomidine (1 mcg), while Group B received 0.125% bupivacaine alone. The primary outcome was the duration of postoperative analgesia and Ramsay sedation scores. Secondary outcomes included 24 hour opioid consumption, Visual Analogue Scale (VAS) pain scores, side effects, and patient satisfaction. Data were analyzed using SPSS version 27.0.

Results: Results show that the duration of postoperative analgesia was significantly longer in Group A than in Group B (727.7 ± 36.3 min vs. 444.0± 36.3 min, p<0.001). Group A maintained consistently lower VAS scores (≤4.0) up to 12 hours after surgery (p<0.001). High-dose rescue analgesia was required by only 6.7% of patients in Group A compared to 33.3% in Group B ( p=0.009). Early Ramsay sedation scores were higher in Group A (p<0.001) but remained within safe limits. Patient satisfaction was significantly higher in Group A (86.6% vs. 56.7%, p=0.013). Adverse effects were mild, self-limiting, and comparable between both groups (p>0.05)

Conclusion: This study visibly shows that adding Dexmedetomidine (1 mcg/ml) to bupivacaine 0.125% increases the postoperative analgesia, improves sedation, reduces opioid needs and pain scores, also improve patients satisfaction and causes very less side effects