Comparison of clonidine and dexmedetomidine as an adjuvant%0 ato 0.5%25 ropivacaine in supraclavicular brachial plexus block a prospective%0a randomized double-blind controlled study
Subarachnoid Block With Low Dose Bupivacaine And Fentanyl In Elderly Hyperten...lgmitra01
read value of mg Fentanyl as mcg- printing error- posted as not available online anymore -
Subarachnoid Block With Low Dose Bupivacaine And
Fentanyl In Elderly Hypertensive Female Patients Undergoing Vaginal Hysterectomy
1Dr. Lalita Gouri Mitra, 2Dr.Suman Chattopadhyay, 3Dr. B. N.Biswas, 4Dr. Manjushree Ray, 5Dr.Pinaki
Mazumder.
INDPAIN FALL Vol. 20 No. 2, 2006
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Subarachnoid Block With Low Dose Bupivacaine And Fentanyl In Elderly Hyperten...lgmitra01
read value of mg Fentanyl as mcg- printing error- posted as not available online anymore -
Subarachnoid Block With Low Dose Bupivacaine And
Fentanyl In Elderly Hypertensive Female Patients Undergoing Vaginal Hysterectomy
1Dr. Lalita Gouri Mitra, 2Dr.Suman Chattopadhyay, 3Dr. B. N.Biswas, 4Dr. Manjushree Ray, 5Dr.Pinaki
Mazumder.
INDPAIN FALL Vol. 20 No. 2, 2006
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Endoscopic ultrasonography (EUS) is an outpatient procedure
During an EUS procedure, an upper gastrointestinal (GI) scope is inserted into the esophagus through the mouth to obtain ultrasonographic as well as endoluminal images of various upper gastrointestinal pathologies.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Comparative Study between Caudal Bupivacaine (0.25%) And Caudal Bupivacaine...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
Endoscopic ultrasonography (EUS) is an outpatient procedure
During an EUS procedure, an upper gastrointestinal (GI) scope is inserted into the esophagus through the mouth to obtain ultrasonographic as well as endoluminal images of various upper gastrointestinal pathologies.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Comparative Study between Caudal Bupivacaine (0.25%) And Caudal Bupivacaine...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
Similar to Comparison of clonidine and dexmedetomidine as an adjuvant%0 ato 0.5%25 ropivacaine in supraclavicular brachial plexus block a prospective%0a randomized double-blind controlled study
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
comparative evaluation of effects of different doses of intrathecal clonidine...Dr Ravi Shankar Sharma
this was the winning paper as best free paper in MPISACON14 GWAlOR,which demonstrates comparative evaluation of effects of different doses of intrathecal clonidine with bupivacaine on post operative pain releif
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr. Niranjan Kumar Verma¹*, Dr. Mahesh Kumar²
¹Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
²Assistant Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
*Address for Correspondence: Dr. Niranjan Kumar Verma, Professor, Department of Anaesthesiology, JLN Medical
College & Hospital, Bhagalpur, India
Received: 04 Sept 2016/Revised: 28 Sept 2016/Accepted: 18 Oct 2016
ABSTRACT- BACKGROUND & OBJECTIVES: Control of post spinal shivering is essential for optimal
peri-operative care as shivering is a cause of discomfort and dissatisfaction in patients undergoing operations under spinal
anaesthesia. The aim of the study is to assess the efficacy and safety of intravenous Clonidine, Dexmedetomidine and
Tramadol in the treatment of post spinal intra-operative shivering.
MATERIALS AND METHODS: In this prospective, double blind, randomized study, 90 ASA grade I and II patients of
patients aged 18 – 50 rears, scheduled for various routine surgical procedures under spinal anaesthesia with hyperbaric
Bupivacaine and who developed shivering were selected. The patients were divided into three groups of 30 each.
Group- C (n=30) comprised of the patients who received Clonidine 0.5mcg/kg intravenously, Group-D (n=30) who
received Dexmedetomidine 0.5mcg/kg IV and Group T (n=30) receiving Tramadol 2 mg/kg (maximum 100mg) IV. The
efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting,
hypotension, bradycardia, sedation and headache, if present, were recorded. All data were analyzed using Chi-square test
and student-t test and expressed in >0.05, (which is insignificant) and < 0.05, (which is significant differences).
RESULTS: There were significant differences in the total response rate between the drugs (p > 0.05), Tramadol showing
the highest response rate (100%). Time taken from the start of treatment to cessation of shivering was significantly less
(p<0.05) in Dexmedetomidine group, but Tramadol group shows complete control of post spinal shivering with none or
lesser and mild degree of side effects with a single dose.
CONCLUSION: Complete control of post spinal intra-operative shivering with less or no severe side effects could be
achieved with Tramadol in comparisons to clonidine and Dexmedetomidine.
Key-words- Post spinal Shivering, Clonidine, Dexmedetomidine, Tramadol
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
.
Similar to Comparison of clonidine and dexmedetomidine as an adjuvant%0 ato 0.5%25 ropivacaine in supraclavicular brachial plexus block a prospective%0a randomized double-blind controlled study (20)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Comparison of clonidine and dexmedetomidine as an adjuvant%0 ato 0.5%25 ropivacaine in supraclavicular brachial plexus block a prospective%0a randomized double-blind controlled study
1. Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine
Journal on Recent Advances in Pain, September-December 2015;1(2):73-77 73
jorapain
Comparison of Clonidine and Dexmedetomidine as
an Adjuvant to 0.5% Ropivacaine in Supraclavicular
Brachial Plexus Block: A Prospective, Randomized,
Double-blind and Controlled Study
1
Usha Bafna, 2
Gaurav Sharma, 3
Sindhu Sapru, 4
Mamta Khandelwal, 5
Varsha Kothari, 6
Rajni Mathur
jorapain
Original Article
10.5005/jp-journals-10046-0015
ABSTRACT
Background: Brachial plexus blockade is the cornerstone of
regional anesthesia practice. This study was done to compare
clonidine and dexmedetomidine as an adjuvant to 0.5%
ropivacaine in supraclavicular brachial plexus block (SCB).
Materials and methods: A prospective, randomized,
double-blind study was done in 120 patients of American
Society of Anaesthesiologist (ASA) grade I and II undergoing
elective upper limb surgery under SCB. Patients were
randomized into three groups. Group 1 (n = 40) received
30 ml of 0.5% ropivacaine, group 2 (n = 40) received 30 ml
of 0.5% ropivacaine with 2 mg/kg clonidine, and group 3
(n = 40) received 30 ml of 0.5% ropivacaine with 1 mg/kg
dexmedetomidine. Onset and recovery time of sensory
and motor block, duration of analgesia and quality of block,
hemodynamic variables, and level of sedation were studied in
the three groups.
Results: Sensory and motor block onset times were shorter in
group 3 than in group 1 and 2 (p < 0.0001). Sensory and motor
block durations and duration of analgesia were longer in group 3
than in groups 1 and 2 (p < 0.0001). Blood pressure and heart
rate were lower in group 3 as compared to groups 1 and 2 (p <
0.0001). The number of patients achieving grade IV quality of
block was higher in group 3 as compared to the other groups.
Conclusion: Dexmedetomidine when added in SCB shortened
the onset of sensory and motor block and enhances the duration
of sensory and motor block and duration of analgesia without
significant side effects.
Keywords: Clonidine, Dexmedetomidine, Ropivacaine,
Supraclavicular brachial plexus block.
How to cite this article: Bafna U, Sharma G, Sapru S,
Khandelwal M, Kothari V, Mathur R. Comparison of Clonidine
and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine
in Supraclavicular Brachial Plexus Block: A Prospective,
Randomized, Double-blind and Controlled Study. J Recent Adv
Pain 2015;1(2):73-77.
Source of support: Nil
Conflict of interest: None
Introduction
Brachial plexus blockade is one of the approaches to
sensorimotor regional neural blockade by which surgical
anesthesia of the upper limb may be achieved. It is
preferred in upper limb surgeries because it has certain
advantages.1,2
It is safer in patients who are at high risk
for general anesthesia, provides good postoperative
analgesia and is economical.
The supraclavicular approach to brachial plexus block
provides anesthesia of the entire upper extremity in the
most consistent and time efficient manner. It has a high
success rate and rapid onset of action. It provides more
complete anesthesia of the plexus, particularly the axillary
and musculocutaneous nerves, and does not require
abduction of the arm to be performed.3,4
Peripheral nerve
blocks have an increasingly important role in ambulatory
anesthesia.5
Various studies have investigated several adjuvants
like adrenaline, dextran 10%, potassium chloride,
neostigmine, opioids, tramadol, dexamethasone,
clonidine, bicarbonate and dexmedetomidine with the
local anesthetics.6-11
Clonidine, a selective alpha 2 adrenergic agonist, has
been used traditionally as an antihypertensive agent.
Various studies have shown that clonidine can be used
as an adjunct to local anesthetics in peripheral nerve
blocks.12
In one study, author concluded that addition of 150 mg
of clonidine to ropivacaine for axillary brachial plexus
blockade prolongs motor and sensory block without an
increase in the incidence of side effects.13
Dexmedetomidine was introduced two decades ago
as a sedative and supplementation to sedation in the
intensive care unit for intubated patients. Studies have
shown that dexmedetomidine is more specific for α-2
adrenoreceptors than clonidine (ratio of α-2:α-1 activity,
1620:1 for dexmedetomidine, 220:1 for clonidine).14,15
1,5,6
Professor, 2
Assistant Professor, 3
Senior Resident
4
Associate Professor
1-6
Department of Anesthesiology, SMS Medical College, Jaipur
Rajasthan, India
Corresponding Author: Gaurav Sharma, Assistant Professor
Department of Anesthesiology, SMS Medical College, Jaipur
Rajasthan, India, e-mail: gauravjln@yahoo.co.in
2. Usha Bafna et al
74
Swami et al compared the effects of clonidine (2 mg/
kg) and dexmedetomidine (1 mg/kg) added to 35 cc 0.5%
bupivacaine in supraclavicular brachial plexus block.21
The aim of our study was to compare the effect
of clonidine 2 ug/kg and dexmedetomidine 1 ug/kg
added to ropivacaine 0.5% on the onset and duration of
sensory and motor block, and total duration of analgesia,
as primary outcome. Effect on hemodynamic variables,
sedation score and the side effects, i.e. hypotension,
bradycardia, headache, dryness of mouth, nausea and
vomiting were also evaluated. This study was done to
find a better additive in SCB along with 0.5% ropivacaine.
We have used ropivacaine because it is less cardiotoxic
than bupivacaine.
MATERIALs AND METHODs
This study was conducted in the Department of
Anesthesiology, SMS Medical College, Jaipur. The
approval for the study was taken from the institutional
ethics committee. This prospective, randomized, double-
blind study was done in 120 patients, of American Society
of Anaesthesiologist (ASA) grade I and II, age 20 to 50
years, body weight 50 to 80 kg who underwent elective
surgery in upper limb.
All patients not willing to participate in the study,
uncooperative patients, patients who were having local
pathology at the site of injection or disability, history of
convulsion, allergy to the drug used, bleeding disorder,
severe neurological deficit, and patients in whom block
was incomplete were excluded from the study.
Pre-anesthetic checkup (PAC) was done a day before
the surgery that included complete history of patients
including any known drug allergy, general and systemic
examination and local examination of supraclavicular
area. Pulse rate, blood pressure, respiratory rate
and weight of the patient were noted. All routine
investigations were done in all patients.
Informed consent was obtained for performance of
block after complete explanation about the study protocol
and the procedure. Visual analog scale (VAS) 0 to 10 was
explained to the patient.
The patients were randomized into three groups each
consisting of 40 patients by chit in box method. A total of
120 chits (40 per group) were made, each chit mentioning
a particular study group. The patients were asked to pick
up a chit from the box. Patients were allocated to the
group mentioned on chit. Study drugs were prepared
and administered to patients as per their respective
allotted groups.
Group 1 (n = 40) received 30 ml of 0.5% ropivacaine,
group 2 (n = 40) received 30 ml of 0.5% ropivacaine with
2 mg/kg clonidine, and group 3 (n = 40) received 30 ml
of 0.5% ropivacaine with 1 ug/kg dexmedetomidine. All
the solutions were diluted with isotonic normal saline to
make a total volume of 32 ml.
Fasting status, consent and PAC were checked and
intravenous access was secured. The patient was placed
in the supine position, with the head turned away and
the ipsilateral arm adducted. The interscalene groove
and mid-point of the clavicle and subclavian artery were
identified. After aseptic preparation of the area, at a point
1.5 to 2.0 cm posterior to midpoint of the clavicle, a skin
wheal was raised with a local anesthetic (lignocaine 2%
plain). Next, a 22 gauge, 50 millimeter ‘short beveled’
needle was passed through the same point in a caudal,
slightly medial and posterior direction, until either a
paresthesia was elicited or the first rib was encountered.
If the first rib was encountered, the needle was moved
over the first rib until a paresthesia was elicited either in
the hand or arm. After eliciting paresthesia and negative
aspiration of blood, medication was injected as per the
respective group allotment.
After performance of nerve block patients were
evaluated for onset of sensory block every 1 minute. The
sensory block was assessed by pin prick with 25 gauge
needle in C5-6 dermatome (Table 1). The onset time of the
sensory block was taken as the time interval in minutes
from the time of injection of the drug, till the sensory
block started appearing, i.e. score > 1.
Motor block was assessed by using modified Bromage
scale (Table 2).
The onset time of the motor block (OTMB), i.e. MBS
score = 1, were recorded in all patients.
Heart rate, noninvasive blood pressure and SPO2
were measured every 5 minutes for first half an hour and
thereafter every 15 minutes. Intraoperatively sedation
was assessed by using a four point scale at 15 minutes
interval. Postoperatively heart rate, noninvasive blood
pressure, sensory block and motor power, sedation
score were recorded at every 30 minutes interval. Visual
analog scale score was assessed postoperatively at 6, 12
and 18 hours. Rescue analgesia was given at VAS score
of 3. Tramadol injection 100 mg IV was given as rescue
Table 1: Sensory block assessment
Score Criteria
0 Sharp pain
1 Touch sensation only
2 Not even touch sensation
Table 2: Motor block assessment (modified Bromage scale)
Score Criteria
0 No block—total arm and forearm flexion
1 Partial block—total forearm and partial arm flexion
2 Almost complete block—inability to flex the arm and
decreased ability to flex the forearm
3 Total block—inability to flex both the arm and forearm
3. Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine
Journal on Recent Advances in Pain, September-December 2015;1(2):73-77 75
jorapain
Table 4: Onset of sensory and motor block, total duration of
sensory and motor block, total duration of analgesia
Parameters Group 1 Group 2 Group 3
Onset of sensory
block in minute
(mean ± SD)
12.2 ± 3.1 10.7 ± 4.0 4.9 ± 1.0
Onset of motor
block in minute
(mean ± SD)
15.8 ± 3.2 12.1 ± 4.1 8.9 ± 1.4
Duration of anal-
gesia in minute
(mean ± SD)
510.7 ± 45.3 713.2 ± 30.2 1014.2 ± 68.0
Duration of motor
block in minute
(mean ± SD)
460.5 ± 45.3 626.2 ± 33.4 769.2 ± 42.7
Duration of sensory
block in minute
(mean ± SD)
483.5 ± 47.0 675 ± 26.8 844 ± 40.5
analgesic. Total duration of analgesia was defined as the
time from injection of drug administration to patient’s
first request for rescue analgesic (i.e. at VAS 3).
The duration of motor block was defined as the
time of attainment of Bromage score 3 of block (onset)
until reversal to Bromage score 1. The incidence of
adverse effects, such as nausea, vomiting, headache,
bradycardia, respiratory depression, and hypotension
were recorded. Hypotension, defined as a decrease of
systolic blood pressure by more than 30% from baseline
or a fall below 90 mm Hg, was treated with incremental
IV doses of mephentermine 5 mg and IV fluid as required.
Bradycardia, defined as heart rate < 50 bpm, were treated
with IV atropine 0.3 to 0.6 mg. Patients were monitored
for 24 hours in postoperative period for adverse effects.
STATISTICS
A study power 80% and alpha level of 0.05 sample size
was calculated for 3 groups (40 patients in each group).
Aimed sample size was 120 patients.
Comparison between the three groups with respect
to demographic variables, intraoperative vitals HR, BP,
RR, SPO2, the onset and duration of sensory and motor
blocks were analyzed by using unpaired t-test. p-value
<0.05 was considered significant.
RESULTS
Mean age, body weight, ASA grading and duration of
surgery were similar in the three groups (Table 3).
The onset of sensory block was 12.2 ± 3.16 minutes in
group1,10.7±4.05minutesingroup2and4.9±1.08minutes
in group 3. It was found to be statistically significant
when we compared group 3 to groups 1 and 2 (p < 0.0001)
(Table 4).
The onset of motor block took 15.8 ± 3.29 minutes in
group 1, 12.1 ± 4.11 minutes in group 2, and 8.9 ± 1.41
minutes in group 3. It was statistically significant when
we compared group 3 to groups 1 and 2 and group 2 to
group 1 (p < 0. 0001) (Table 4).
Duration of analgesia was 510.75 ± 45.31 minutes in
group 1, 713.25 ± 30.24 minutes in group 2 and 1014.25 ±
68.00 in group 3. It was statistically significant when
we compared group 3 to group 1 and 2 and group 2 to
group 1 (p < 0.0001) (Table 4).
Duration of motor block was 460.5 ± 45.344 minutes in
group 1, 626.25 ± 33.42 minutes in group 2 and 769.25 ±
42.75 in group 3. It was statistically significant when we
compared group 3 to groups 1 and 2 and group 2 to group
1 (p < 0. 0001) (Table 4).
Duration of sensory block was 483.5 + 47.09 minutes
in group 1, 675 + 26.89 minutes in group 2 and 844 + 40.56
minutes in group 3. It was statistically significant when
Table 3: Demographic profile
Variables
Group 1
(n = 40)
Group 2
(n = 40)
Group 3
(n = 40) p-value
Age (years)
(mean ± SD)
34.2 ± 10.1 31.9 ± 12.9 25.8 ± 7.5 1.0
Body weight
(kgs) (mean
± SD)
56.8 ± 4.2 51.5 ± 7.7 56.4 ± 3.0 0.9
Duration
of surgery
(minute)
(mean ± SD)
72.5 ± 14.8 71.2 ± 12.5 72.2 ± 16.7 2.0
ASA grade I/II 18/22 21/19 24/16 1.8
Gender (M/F) 23/17 26/14 29/11 0.7
p-value Groups 1 and 2 Groups 1 and 3 Groups 2 and 3
Onset of
sensory
0.0565 <0.0001 <0.0001
Onset of
motor
<0.0001 <0.0001 <0.0001
Duration of
analgesia
<0.0001 <0.0001 <0.0001
Duration of
motor block
<0.0001 <0.0001 <0.0001
Duration
of sensory
block
<0.0001 <0.0001 <0.0001
we compared groups 3 to groups 1 and 2 and group 2 to
group 1 (p < 0. 0001) (Table 4).
Mean pain score in group 1 was 2.65 + 0.48, in group 2
was 1.275 + 0.45 and in group 3 was 0.25 + 0.439. The mean
pain score in group 3 is significantly lower as compared
to groups 1 and 2.
In group 1, all 40 patients were awake and alert. In
group 2 (27/40) were awake and alert and 13 patients
were drowsy. In group 3(18/40) were awake and alert
and 22 patients were drowsy (Table 5).
There was no significant difference between groups
regarding the incidence of adverse effects (Table 6).
4. Usha Bafna et al
76
DISCUSSION
Brachial plexus block was achieved by classical supra-
clavicular approach and satisfactory surgical anesthesia
was attained in all the cases for various types of upper
limb surgeries.
A 2 mg/kg body weight of clonidine was added with
ropivacaine in one group of patients based on works done
by El Saied et al which concluded that addition of 150 mg
of clonidine to ropivacaine for axillary brachial plexus
blockade prolongs motor and sensory block without an
increase in incidence of side effects.13
In contrast, Culebras et al showed that clonidine
(150 mg) added to 40 ml 0.5% bupivacaine did not prolong
postoperative analgesia.16
Casati evaluated the effects of clonidine 1 ug/kg
added to ropivacaine and found longer onset time to
establish block in clonidine group.17
Bernard et al observed that small doses of clonidine
30 to 90 mg in combination with lidocaine administered
in axillary block reduced sensory block onset time and
significantly prolonged the duration of analgesia (p <
0.01). In this study higher doses of clonidine (300 mg) were
associated with significant adverse effects.18
Wolfgang et al studied the effect of clonidine as
adjuvant for bupivacaine, mepivacaine and ropivacaine
foraxillaryplexusblock.Clonidineproducedprolongation
in bupivacaine and mepivacaine groups but did not
produce additional block in ropivacaine group.19
Aliya Esmaoglu et al have reported that 100 ug dose
of dexmedetomidine when used as an adjuvant for
ropivacaine in axillary block shortens the onset of sensory
and motor block and prolongs duration of blockade
without significant change in heart rate, blood pressure
and sedation.20
Swamietalcomparedtheeffectsofclonidine(2ug/kg)
and dexmedetomidine (1 mg/kg) added to 35 cc 0.5%
bupivacaine in supraclavicular brachial plexus block
and found that dexmedetomidine enhanced the duration
of sensory and motor block and also the duration of
analgesia. In our study, we observed that both clonidine
and dexmedetomidine have enhanced the duration of
sensory and motor block and duration of analgesia.21
RachanaGandhietalobservedan8hoursprolongation
in duration of analgesia and motor block when 30 mg
dexmedetomidine was added to bupivacaine.22
In another study, Kenan kayqusuz et al observed a
3.5 hours prolongation of analgesia when dexmedetomi-
dine 100 mg was added to levobupivacaine. In our study,
we have found a significant prolongation of analgesia
(5 hours) with dexmedetomidine compared to clonidine.
This shows that the dose of dexmedetomidine of 1 mg/kg
is appropriate for brachial plexus block and in fact supe-
rior to a higher dose of clonidine (2 mg/kg).23
In our study in groups 1 and 2, no significant change
in heart rate was seen in the intraoperative as well as
postoperative period. However in group 3 statistically
significant reductions in heart rate were observed.
These results are consistent with the studies done by
Adnan et al24
and Swami et al who found no change
in heart rate with clonidine in axillary brachial block,
and supraclavicular brachial plexus block respectively;
and to the results of Aliya Esmaoglu et al and Swami
et al who described significant bradycardia with
dexmedetomidine.20,21
Blood pressure (both systolic and diastolic) showed no
difference in groups 1 and 2. The blood pressure values in
group3showedsignificantreductionbothintraoperatively
and postoperatively as compared to baseline values but no
active clinical intervention was required. These findings
are in line with the works of El Saied et al who found
no significant changes in blood pressure when 150 mg
clonidine was added to ropivacaine. Aliya Esmaoglu
et al and Swami et al have observed a decrease in the
blood pressure and heart rate when dexmedetomidine
was added to local anesthetic in brachial plexus block.
CONCLUSION
Theupperlimbsurgeriesperformedundersupraclavicular
brachial plexus nerve block with 0.5% ropivacaine and
dexmedetomidine (1 mg/kg) as an adjuvant result in
early onset of sensory and motor blockade, prolongation
of the duration of sensory and motor blockade and
postoperative analgesia with better quality of block as
compared to clonidine (2 mg/kg). The patient remained
comfortable in postoperative period with considerable
therapeutic benefit and without any potential adverse
effects.
Table 6: Adverse effect
Sl. no. Adverse effects Group 1 Group 2 Group 3
1 Hypotension 0 0 1
2 Bradycardia 0 0 2
3 Nausea/vomiting 0 0 0
4 Headache 0 0 0
5 Dryness of mouth 0 0 0
Table 5: Degree of sedation
Score Degree of sedation Group 1 Group 2 Group 3
1 Awake and alert 40 27 18
2 Drowsy but responsive
to command
0 13 22
3 Very drowsy but
responsive to pain
0 0 0
4 Unresponsive 0 0
5. Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine
Journal on Recent Advances in Pain, September-December 2015;1(2):73-77 77
jorapain
References
1. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ,
Franco CD, Hogan QH. Upper extremity regional anesthesia.
Reg Anesth Pain Med 2009 Mar-Apr;34(2):134-170.
2. LivingstonEM,MD,HippolyteWertheim,MD.NewYork,N.Y:
Brachial plexus block: Its clinical application. Anaesth Analg
J 1927 Jun;6(3):149-156.
3. Hickey, Rosemary; Ramamurthy, Somayaji. Brachial plexus
block. Current Opinion in Anaesthesiology 1993 Oct;6(5):
799-802.
4. Kulenkampff D. Brachial plexus anaesthesia, its indications,
technique, and dangers. Ann Surg 1928 Jun;87(6):883-891.
5. Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS,
Steele SM. Peripheral nerve block techniques for ambulatory
surgery. Anesth Analg 2005;101(6):1663-1676.
6. Bazin JE, Massoni C, Bruell P, Fenies V. The addition of opoids
to local anaesthetics in brachial plexus block. The comparative
effectsofmorphine,buprenorphineandsufentanil.Anaesthesia
1997 Sep;52(9):558-562.
7. Bone HG, Van A, Ken H, Booke M, Burkle H. Enhancement of
axillary brachial plexus block anaesthesia by co-administration
of neostigmine. Reg Anaesth Pain Med 1999;24(5):405-110.
8. Kapral S, et al. Tramadol added to mepivacaine prolongs the
duration of an axillary brachial plexus blockade. Anaesth
Analg 1999 Apr;88(4):853-856.
9. Karakaya D, et al. Addition of fentanyl to bupivacaine
prolongs anaesthesia and analgesia in axillary brachial plexus
block. Reg Anaesth Pain Med 2001; 26(5):434-438.
10. Keeler JF, Simpson KH, Ellis FR, Kay SP. Effect of addition of
hyaluronidase to bupivacaine during axillary brachial plexus
block. Br J Anaesth 1992 Jan;68(1):68-71.
11. Khosa DS, et al. Effect of adding potassium chloride to
lignocaine and bupivacaine solution on the onset time and
duration of brachial plexus block. IJA 1990;38:119.
12. Buttner J, Ott B, Klose R. Effect of adding clonidine to
mepivacaine for brachial plexus block. Anaesth 1992;41(9):
548-554.
13. El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs
the effect of ropivacaine for axillary brachial plexus block.
Can J Anaesth 2000 Oct;47(10):962-967.
14. Shukry M, Miller JA. Update on dexmedetomidine; use in
nonintubated patients requiring sedation for surgery. Ther
Clin Risk Manag 2010 Apr 15;6:111-121.
15. Travers AM. Sedation in the ICU. SA J Anaesth Analg 2010;
16(1):96-100.
16. Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine
combined with a long acting local anaesthetic in brachial
plexus block. Anaesth Analg 2001 Jan;92(1):199-204.
17. Casati A, Magistris L, Beccaria P, Cappelleri GG, Aldegheri G,
fanelli G. Improving postoperative analgesia after axillary
brachial plexux aesthesia with 0.75% ropivacaine: a double
blind evaluation of adding clonidine. Minerva Anesthesiol
2001 May;67(5):407-412
18. Bernard JM, Macaire P. Dose range effects of clonidine added
to lidocaine for brachial plexus block. Anaesthesiology
1997;2:277-284.
19. Wolfgang T, Christoph D. Clonidine as adjuvant for mepi-
vacaine, ropivacaine and bupivacaine for axillary brachial
plexus blockade. Can J Anaesth 2001 Jun;48(6):522-525.
20. EsmaogluA,YegenogluF,AkinA,TurkCY.Dexmedetomidine
added to levobupivacaine prolongs axillary brachial plexus
block. Anesth Analg 2010 Dec;111(6):1548-1551.
21. Swami SS, Keniya VM, Ladi SD, Rao R. Indian journal of
anaesthesia: comparison of dexmedetomidine and clonidine
(α2 agonist drugs) as an adjuvant to local anaesthesia in
supraclavicular brachial plexus block: A randomised double-
blind prospective study; 2012;56(3):243-249.
22. Gandhi R, Shah A, Patel I. Use of dexmedetomidine with
bupivacaine in brachial plexus block. National J Medical
Research 2012 Jan-Mar;2(1):67.
23. Kaygusuz K, Kol IO, Duger C, Ozturk SGH, Aydin UKR,
Mimaroglu C. Effects of adding dexmedetomidine to
levobupivacaine in axillary brachial plexus block. Current
Therapeutic Research 2012 Jun;73(3):103-111.
24. Adnan T, Eliff AA, Gulnazl AK. Clonidine as an adjuvant for
lidocaine in axillary brachial plexus block in patients with
chronic renal failure. Acta Anaesth Scand 2005 Apr;49(4):
563-568.