Harsukh Educational Charitable Society International Journal of Community Health and Medical Research
Volume 5 Issue 4 Oct-Dec 2019
|Comparison analysis of dexamethasone and tramadol as adjuvant to levobupivacaine in supraclavicular block|
|Prateek Singh, Satyam Yadav|
Anaesthesia, defined as a loss of sensation with or without loss of consciousness, can be effectively achieved with a wide range of drugs with very diverse chemical structures.1 The list of such compounds includes not only the classic anesthetic agents, such as the general and local anesthetics, but also many central nervous system (CNS) depressants, such as analgesics, sedative, hypnotics (barbiturates and benzodiazepines), anticonvulsants, and skeletal muscle relaxants.1 Although various mechanisms of action are attributed to these agents, ultimately they all produce their anesthetic actions by interfering with conduction in sensory neurons and sometimes also motor neurons.2 The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which are often missed during interscalene and axillary approach. Levobupivacaine exerts its pharmacological action through reversible blockade of neuronal sodium channels. Myelinated nerves are blocked through exposure at the nodes of Ranvier more readily than unmyelinated nerves.3 Recently dexamethasone has been studied as a local anaesthetic adjuvant for peripheral nerve block. As a perineural adjuvant the safety profile of dexamethasone is promising. No trial reported neurotoxicity attributable to dexamethasone. Its addition with bupivacaine in brachial plexus block has been studied in the past suggesting varying results.5 Tramadol used with local anaesthetics inhibits the reuptake of serotonin from nerve endings and potentiates the block effects. The local effect of dexamethasone or other adjuvants on the nerve remains unclear and local neurotoxicity should be ruled out.5 The present study evaluated and compared dexamethasone and tramadol as adjuvant to levobupivacaine in supraclavicular block.
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