Monitored anesthesia care with propofol or dexmedetomidine for patients undergoing upper limb surgeries under brachial plexus blockade: a comparative study

Kumkum Gupta, Vasundhra Tyagi, Prashant K Gupta, Bhawana Rastogi, Manish Jain, Manoranjan Bansal

Ain-Shams Journal of Anaesthesiology 2016 9(4):563-568

Background Brachial plexus block is widely used for upper limb surgeries but intraoperatively patients remain aware. The present study aimed to compare the sedative efficacy and safety of propofol infusion versus dexmedetomidine infusion for monitored anesthesia care during upper limb surgeries under ultrasound (US)-guided brachial plexus blockade. Patients and methods Sixty adult consented patients of American Society of Anesthesiologists physical status I–III of both sexes were given 20 ml of 0.75% ropivacaine (150 mg) for brachial plexus blockade under US guidance. The patients were randomized into two groups of 30 patients each, to receive either propofol infusion [group I (P)] or dexmedetomidine infusion [group II (D)] during the intraoperative period. The primary goals were to achieve a sedation score of 2–3 on the Ramsay sedation scale and to compare the duration of postoperative analgesia assessed using the visual analog scale. The hemodynamic stability, respiratory depression, or any complication due to technique or medications was also recorded as secondary outcomes. Results US guidance helped visualization of the nerves, the needle, and the spread of local anesthetic at the brachial plexus block site. Desired sedation score of 2–3 was effectively achieved with intraoperative infusions of dexmedetomidine and propofol. Hypotension occurred in 11 patients of the propofol group, whereas no episode of hypotension was noted in the dexmedetomidine group. Bradycardia was evident in five patients of the dexmedetomidine group. The duration of postoperative analgesia with dexmedetomidine infusion was significantly prolonged when compared with propofol infusion as assessed using visual analog scale. Respiratory depression did not occur in any patient. No adverse events inherent to sedative medication or technique were observed in any patient. Conclusion The clinical efficacy and safety of dexmedetomidine was better than propofol due to prolonged postoperative analgesia and intraoperative hemodynamic stability without respiratory depression.

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