A comparative study of the effect of Dexmedetomidine and Nalbuphine as an adjuvant to Levobupivacaine in ultrasound guided supraclavicular brachial plexus block: A prospective randomized, double blind study

Supraclavicular brachial plexus blockade  is the common approach to provide surgical anesthesia of upper limb, was first described by Kulenkampff in 1911.(1) It is an efficient regional anesthetic technique for upper limb surgeries. Which is a reliable, alternative to general anesthesia for certain group of patients as it is devoid of undesired effects of general anesthesia and stress of laryngoscopy. The postoperative period is also free from pain, nausea, vomiting, and respiratory depression. Adjuvants are added to local anaesthetics to improve various block characteristics in terms of onset of action ,duration of analgesia with lesser adverse effect. Various study has been done using different types of adjuvants in different combination of local anaesthetics for various nerve blocks. In our study we will use levobupivacaine LA because it is relatively safe in terms of less cardiac and neurotoxic adverse effects. Dexmedetomidine is a highly selective an alpha 2 agonist which, when used as an adjuvant , prolongs the duration of action  without causing respiratory depression. Nalbuphine is recently introduced opioid agonist-antagonist. Unlike other opioids it has got ceiling effect. Furthermore,use  of ultrasound (US) has significantly improved the quality of nerve blocks by direct visualization of nerves and related anatomical structures, needle trajectory and spread of local anesthetics (LAs) during injection [2-7]. In addition, US guidance increases success rate, minimizes LAs volume needed for effective nerve block, and avoids potential complications such as intraneural or intravascular injection [2,4,5]. In this study, we plan to compare the efficacy of dexmedetomidine and nalbuphine as an adjuvant to levobupivacaine in ultrasound guided supraclavicular brachial plexus block.