Efficacy of Clonidine as an Additive on the Duration of Action of Brachial Plexus Block Performed Under Ultrasound and Nerve Locator Guidance: A Prospective Randomized Study

BACKGROUND: Clonidine, an alpha(2) agonist, when added to local anesthetics in different regional and neuraxial blocks reduces the onset time, improves the efficacy, and increases the duration of postoperative analgesia. AIMS: This study evaluated the effect of bupivacaine clonidine combination in ultrasound and nerve locator-guided supraclavicular brachial plexus block for upper limb surgeries. SETTINGS AND DESIGN: This was a prospective, randomized, controlled, double-blind study carried out in a tertiary care center in South India on 50 patients with American Society of Anesthesiologists (ASA) physical status classes I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block. MATERIALS AND METHODS: Eligible participants were randomized equally to either Group B who received 20 ml of bupivacaine and 7 mL of 2% lignocaine or Group C who received 20 ml of bupivacaine, 7 ml of 2% lignocaine, and 100 μg of clonidine. STATISTICAL ANALYSIS: Continuous outcome variables were tested for statistical significance using Student's t-test, and Mann–Whitney U-test was used for outcomes that were nonnormally distributed. Categorical variables were compared using Fisher's exact test. P <0.05 was considered as statistically significant. RESULTS: The onset of sensory and motor blockade was significantly faster (P < 0.05) in Group C compared to Group B. The duration of sensory and motor block and the duration of analgesia were significantly longer in Group C (P < 0.001). The sedation in Group C patients was significantly more (P < 0.05) when compared to Group B, but none of the sedation scores exceeded 3 on the Ramsay sedation score. Hemodynamic parameters did not differ between groups (P > 0.05). CONCLUSION: The inclusion of 100 μg of clonidine with bupivacaine in ultrasound-guided supraclavicular brachial plexus blocks prolongs both sensory and motor blockade. It also provides significant postoperative analgesia and mild sedation which is beneficial in the immediate stressful postoperative period.