Analgesic Efficacy of Dexmedetomidine as an Adjunct in Ultrasound-Guided Supraclavicular Block for Pediatric Upper Limb Surgeries: A Randomised Double Blind Controlled Study

Background and Aims: Dexmedetomidine has been studied extensively in peripheral nerve blocks in adults. However, a literature search revealed no study regarding its use in the ultrasound-guided supraclavicular block in pediatrics. Hence, the present study evaluated the analgesic efficacy of dexmedetomidine in combination with bupivacaine in the ultrasound-guided supraclavicular block in pediatric patients undergoing upper limb surgeries. Material and Methods: This prospective randomized, double-blind study was conducted in fifty patients of American Society of Anesthesiologists (ASA) physical status grade I and II, aged 3-12 years, undergoing elective upper limb surgeries. Patients were divided into two groups of 25 each. Group A received general anesthesia (GA) and ultrasound(USG)- guided supraclavicular brachial plexus block with 0.25% bupivacaine 0.3ml/kg, and 0.5ml normal saline. Group B patients received GA and USG guided supraclavicular block with 0.25% bupivacaine 0.3ml/kg and dexmedetomidine 1 µg/kg in a volume of 0.5 ml. The time to first rescue analgesic request, pain scores, consumption of postoperative rescue analgesics, hemodynamics, patient satisfaction and adverse effects were noted. For normally distributed variables, Unpaired Student’s t test and Chi-square test were used. Mann Whitney Test was used for variables that were not normally distributed.  Results: Patients receiving dexmedetomidine had a longer time to the first analgesic request in the postoperative period (p-value:0.004),reduced consumption of rescue analgesics (p-value: 0.002), and better satisfaction scores (p-value: 0.003). Conclusion: USG-guided supraclavicular block with bupivacaine and dexmedetomidinein pediatric patients provides superior analgesia in terms of the longer time to the first rescue analgesic request, reduced requirement of rescue analgesics, and stable hemodynamics. In addition, the use of dexmedetomidine results in better patient satisfaction as compared to bupivacaine alone, without any significant adverse effects.