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Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block

[La clonidine comme adjuvant à la mépivacaïne, la ropivacaïne et la bupivacaïne pour une anesthésie par bloc brachial axillaire périvasculaire]

Wolfgang Erlacher, MD^*, Christoph Schuschnig, MD^*, Herbert Koinig, MD, Peter Marhofer, MD, Matthias Melischek, MD, Nikolaus Mayer, MD and Stephan Kapral, MD

^* From Department of Anaesthesia and Intensive Care, Hospital Lainz and the
Department Of Anaesthesia and General Intensive Care University of Vienna, Vienna, Austria.

Address correspondence: Dr. Wolfgang Erlacher, Department of Anaesthesia and General Intensive Care, Krankenhaus Lainz, Wolkersbergenstr. 1, A–1130 Vienna, Austria. Phone: 0043-1-80110-2646; Fax: 0043-1-80110-2696; E-mail: Wolfgang.Erlacher{at}univie.ac.at

Purpose: To evaluate the effects of clonidine on three local anesthetics (mepivacaine 1%, ropivacaine 0.75% and bupivacaine 0.5%) with comparable potency and almost the same concentration-response relationship.

Methods: One hundred and twenty trauma-patients were randomly allocated into six groups. In the control-groups (Mo/Ro/Bo) brachial plexus was performed using 40 mL of local anesthetic plus 1 mL of NaCL 0.9%. In the clonidine-groups (Mc/Rc/Bc) brachial plexus was performed using each 40 mL of drug plus 1 mL (0.150 mg) of clonidine. Onset-time and the duration of the sensory block were recorded. Data are expressed as mean ± SD.

Results: According to the average sensory block determined by a visual analog scale in the median, ulnar and radial nerve distributions and ranging from 100 (no sensory blockade) to 0 (complete sensory blockade), both mepi-groups showed a rapid onset (at 10 min: -Mo 20 ± 15 / Mc 19 ± 14; at 30 min: -Mo 3 ± 4 / Mc 5 ± 4). The ropi-and bupi- groups both had a longer onset time (at 10 min: -Ro 23 ± 19 / Rc 25 ± 22 / Bo 24 ± 15; at 30 min -Ro1 0 ± 6 / Rc11 ± 6 / Bo 12 ± 4). The onset time in group-Bc was significantly prolonged (at 10 min: -45 ± 21; at 30 min: -20 ± 6).

Duration of motor blockade was prolonged by clonidine only in the mepivacaine and bupivacaine groups; (in minutes: Mo 212 ± 47 -Mc 468 ± 62; Ro 702 ± 52 -Rc 712 ± 82; Bo 728 ± 36 -Bc 972 ± 72).

Conclusion: The present study shows that the addition of clonidine has a different impact on each of the three local anesthetics investigated in terms of onset and duration of block.

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