Comparative Analysis Of Dexmedetomidine And Dexamethasone As An Adjuvant To 0.5%Ropivacaine On Onset Of Ultrasound Guided Supraclavicular Brachial Plexus Block In Patients Undergoing Upper Limb Surgeries

After preparation, patients will be randomized into two groups of 33 each, where group A will receive 28ml of 0.5%Ropivacaine + 1mcg/kg Dexmedetomidine (diluted in 2ml normal saline) and group B will receive 28ml of 0.5%Ropivacaine + 8mg Dexamethasone (2ml). Anesthetist involved in drug administration and observation will be blinded to coded drugs prepared by another anesthetist who will not be involved further in the study. A detailed history will be taken regarding mode of injury, any pre-existing disease and previous surgery followed by local examination of patient will be done to rule out any systemic disease. On shifting to the operation theatre, standard monitoring like pulse-oximeter, electrocardiogram and non-invasive blood pressure measurement will be started. Supraclavicular brachial plexus block will be performed under aseptic measures with the patient lying supine with head turned 30o toward the contralateral side. A linear 7-13 MHz ultrasonography probe (ACUSON P500, digital color doppler ultrasound Siemens Germany) will be placed in supraclavicular fossa and slightly angled towards the thorax. The brachial plexus appears as multiple hypoechoic disks just superficial and lateral to the subclavian artery. After identification of brachial plexus, the proposed puncture site will be infiltrated with 1ml of 2% lignocaine. Then, 25-gauge spinal needle will be inserted using in plane technique, from lateral to medial direction until the tip is visualized near the brachial plexus. After careful aspiration for blood, study drugs will be injected in 5ml increments to obtain uniform spread around brachial plexus. Patient will be assessed every 5 minutes till complete sensory and motor block or for 30 minutes, whichever is earlier, using three point scale with pin prick technique for sensory block and modified bromage scale for motor block. Side effects and complications of the technique and drugs will be monitored and appropriately treated. Outcome of study will be to compare the time of onset of sensory and motor block between 2 groups.

Inclusion criteria

• Patients scheduled for upper limb surgery below mid-humerus level
• Patients aged 18 to 70 years
• Patients with ASA class I, II and III
• Male and non-pregnant females Exclusion Criteria
• Patients refusal
• Patients with pre-existing peripheral neuropathy of the upper limb
• Patients with the Infection at block site
• Patients with history of ischemic heart disease
• Patients with bleeding disorder or deranged coagulation profile
• Patients with known history of allergy to local anaesthetic or any other drugs used