Ultrasound Guided Supraclavicular Brachial Plexus Block

Purpose: To evaluate the effect of adding dexamethasone 5mg or dexmedetomedine 1ug/kg on levobupivacaine action during ultrasound guided supraclavicular brachial plexus block technique. Material and Methods: In this prospective randomaized double blind clinical study, 120 patients were equally divided into four groups according to the injectate LA into: Group B: 30ml of bupivacaine 0.25%. Group L: 30ml of levobupivacaine 0.25%. Group L +D: 30ml of levobupivacaine 0.25% + 5mg of dexamethasone. Group L + DEX: 3 0ml of levobupivacaine 0.25% + 1ug/kg of dexmedetomedine. All patients had recievied single shot ultrasound guided supraclavicular brachial plexus block with using nerve stim-ulation. Parameters recorded in the study include the following: Onset and duration of both sensory and motor block and duration of analgesia. Haemodynamic changes (blood pressure and heart rate) and a verbal numerical pain rating scale (V.N.P.R.S.) during the first 24 hours. Serum cortisol level at 1 and 4 hour post injection. Total analgesic requirements calculated. Any evidence of complication. The patients satisfaction with the anesthetic technique was assessed. Data were analyzed with the paired sample t-test, analysis of variance ANOVA, post hoc test and the Chi-square test. p 0.05 was considered statistically significant. p 0.00 1 was considederd highly significant. Results: Regarding onset of sensory and motor block there was high significance between the four groups being shorter onset of block in Group L, Group L +D and Group L +DEX than Group B with no significance in between Group L, Group L +D and Group L + DEX. The duration of sensory, motor block and the duration of analgesia were significantly longer in Group L +D than Group L + DEX, Group L and Group B respectively. Haemodynamics were better cotrolled in Group L +D and Group L + DEX than Group B and Group L but in Group L + DEX there was significant hypotension and decrease heart rate. Also pain scores were significantly low in Group L + D and Group L + DEX than Group L and Group B. Serum cortisol levels at 1 and 4 hours were non significantly changed in Group L + D and Group L + DEX denoting better suppression of stress reponse to surgery than Group L and Group B. Patients were satisfied with the anesthetic technique. Conclusions: The addition of dexamethasone or dexme-detomedine to levopubivacaine prolongs sensory and motor block duration and duration of analgesia with no effect on onset of block and better control of haemodynamics and serum cortisol.