IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13, Issue 11 Ver. I (Nov. 2014), PP 54-58 www.iosrjournals.org www.iosrjournals.org 54 | Page Comparison of the effects between clonidine and epinephrine added with bupivacine in brachial plexus block. Dr. A. Ashok Kumar MD 1 , Dr. V. S. Suresh MD 2 1 (Department of anesthesiology, Sri Ramachandra Medical college and Research institute,India) 2 (Department of anesthesiology, Billroth Hospital,India) Abstract : Background: Demonstration of alpha ฀ adrenoreceptors in the peripheral nervous system has made to study the effects of various alpha adrenergic drugs with local anesthetics in peripheral nerve blocks. This study is designed to compare the efficacy of clonidine and epinephrine when added to bupivacaine in brachial plexus block. Methods: Forty ASA 1 and 2 patients undergoing upper limb surgeries under supraclavicular brachial plexus block were divided into two groups in a randomized double blinded fashion. Group BA received 5 mcg/ml of adrenaline and group BC recieved mcg/ kg of clonidine along with 30 ml of 0.375% bupivacaine. Onset of sensory and motor blockade, duration of analgesia, hemodynamic stability were studied in both the groups. Results: Onset of sensory and motor blockade were 6.25+ 1.33 minutes and 3.80+ 0.834 minutes respectively in group BA and 5.85+ 1.26 minutes and 3.55+ 1.05 minutes respectively in group BC which were not statistically significant between the two groups. Duration of analgesia was 7.12+ 0.63 hours in group BA and 12.69+ 1.28 hours in group BC which was statistically significant (p value 0.001). There were no significant difference in the hemodynamic parameters between the two groups. Conclusion: Addition of clonidine to bupivacaine in supraclavicular brachial plexus block provides a significant advantage over epinephrine to bupivacaine in terms of postoperative analgesia without any significant side effects. Keywords: adrenaline,bupivacaine, clonidine, supraclavicular brachial plexus block, upper limb surgeries I. Introduction Brachial plexus 1 block was first performed by William Stewart Halsted in 1889.He directly exposed the brachial plexus in the neck to perform the block and used cocaine. Hirschel first described the percutaneous approach to the brachial plexus. Kulenkampff first described the classical supraclavicular approach to the brachial plexus. Peripheral nerve blocks provide ideal operating conditions when used optimally. They are said to cause least interference with the vital physiological functions of the body and reduced stress response avoiding polypharmacy with an alert awake and co-operative patient when compared to other conventional techniques. Adequately administered regional anesthesia not only provide excellent intraoperative pain relief but also good postoperative analgesia. The demonstration of alpha ฀ adrenoreceptors in the peripheral nervous system has prompted many investigations on the effects of using various ฀ adrenergic drugs in combination with local anesthetics in peripheral nerve blocks to prolong post operative analgesia. This study is designed to compare the efficacy of clonidine and epinephrine for prolongation of post operative analgesia when added to bupivacaine in brachial plexus block. II. Methods After institutional ethical committee approval and written informed consent, a double-blinded randomized prospective clinical study was carried out on 40 American Society of Anesthesiology (ASA) Grade I and II patients of both sex, aged 18-65 years, undergoing various surgeries on the upper limb under supraclavicular brachial plexus block. The study was conducted in two groups of 30 patients each. The patients were randomly assigned using "slips in a box technique" to one of the following groups: BA – 30 ml of 0.375% bupivacaine with 5 mcg/ml of epinephrine BC - 30 ml of 0.375% bupivacaine with 1 mcg/kg of clonidine Patients on adrenoreceptor agonist or antagonist therapy, with known hypersensitivity to local anaesthetic drugs, local infection, coagulation disorders, uncontrolled diabetes mellitus, pregnant and lactating women and pre-existing peripheral neuropathy, were excluded from the study. On arrival of the patient in the operating room baseline heart rate, ECG, blood pressure and oxygen saturation were recorded. An intravenous access was obtained in the unaffected limb. All patients received brachial plexus block through the supraclavicular approach by subclavian perivascular technique 2 by an experienced anesthesiologist different from the one assessing the patient intra- and post-operatively. Both were blinded to the groups.