Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Experimental Trials

Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

Ali Ghasemi, Mohsen Chamanara, Babak Paknejad, Mojtaba Yousefizoshk, Ebrahim Hazrati

Downloads: 0
Views: 6


Brachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB.

In this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to 2 equal study groups (n = 20), receiving 1 mL of 5 µg.mL-1 sufentanil (group S) or 1 mL of 100 µg.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40).

The duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0∼130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0∼130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0∼7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0∼-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting.

Our study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.


Brachial plexus block,  Bupivacaine,  Dexmedetomidine,  Sufentanil,  Local anesthesia,  Ultrasonography


1 Y. Ping, Q. Ye, W. Wang, et al. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: a meta-analysis of randomized controlled trials Medicine, 96 (2017), p. e5846

2 M.A. Hamed, S. Ghaber, A. Reda Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: a randomized controlled study Anesth Essays Res, 12 (2018), pp. 475-479

3 J.M. Pester, M. Varacallo Brachial Plexus Block Techniques. StatPearls StatPearls Publishing StatPearls Publishing LLC, Treasure Island (FL) (2020)

4 J. Cabaton, L. Nové-Josserand, L. Mercadal, et al. Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: a randomised noninferiority study Eur J Anaesthesiol, 36 (2019), pp. 778-786

5 J.A. Patacsil, M.S. McAuliffe, L.S. Feyh, et al. Local anesthetic adjuvants providing the longest duration of analgesia for single- injection peripheral nerve blocks in orthopedic surgery: a literature review AANA J, 84 (2016), pp. 95-103

6 N.S. Bailard, J. Ortiz, R.A. Flores Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations Am J Health Syst Pharm, 71 (2014), pp. 373-385

7 M. Opperer, P. Gerner, S.G. Memtsoudis Additives to local anesthetics for peripheral nerve blocks or local anesthesia: a review of the literature Pain Manag, 5 (2015), pp. 117-128

8 H. Kaur, G. Singh, S. Rani, et al. Effect of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: a randomized double-blind prospective study J Anaesthesiol Clin Pharmacol, 31 (2015), pp. 333-338

9 D.M. Popping, N. Elia, E. Marret, et al. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials Anesthesiology, 111 (2009), pp. 406-415

10 J.E. Bazin, C. Massoni, P. Bruelle, et al. The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil Anaesthesia, 52 (1997), pp. 858-862

11 J.E. Bazin, C. Massoni, D. Groslier, et al. Brachial plexus block: effect of the addition of sufentanil to local anesthetic mixture on postoperative analgesia duration Ann Fr Anesth Reanim, 16 (1997), pp. 9-13

12 N. Farooq, R.B. Singh, A. Sarkar, et al. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study Anesth Essays Res, 11 (2017), pp. 730-739

13 A. Esmaoglu, A. Mizrak, A. Akin, et al. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia Eur J Anaesthesiol, 22 (2005), pp. 447-451

14 N. Nazir, S. Jain A randomized controlled trial study on the effect of adding dexmedetomidine to bupivacaine in supraclavicular block using ultrasound guidance Ethiop J Health Sci, 26 (2016), pp. 561-566

15 N. Hussain, V.P. Grzywacz, C.A. Ferreri, et al. Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in brachial plexus block: a systematic review and meta-analysis of 18 randomized controlled trials Reg Anesth Pain Med, 42 (2017), pp. 184-196

16 S. Antonucci Adiuvants in the axillary brachial plexus blockade. Comparison between clonidine, sufentanil and tramadol Minerva Anestesiol, 67 (2001), pp. 23-27

17 C. Sandeep, C.H. DMR, T. Kundurthi, et al. Comparative evaluation of subarachnoid block with low dose bupivacaine and fentanyl versus low dose bupivacaine and sufentanil in patients undergoing inguinal surgeries Int J Clin Trials, 6 (2019), p. 84

18 J.P. Monk, R. Beresford, A. Ward Sufentanil Drugs, 36 (1988), pp. 286-313

19 H. Bouaziz, B.P. Kinirons, D. Macalou, et al. Sufentanil does not prolong the duration of analgesia in a mepivacaine brachial plexus block: a dose response study Anesth Analg, 90 (2000), pp. 383-387

20 F.W. Abdallah, A. Abrishami, R. Brull The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis Anesth Analg, 117 (2013), pp. 271-278

21 T. Ghatak, S. Samanta Accidental intra-arterial dexmedetomidine injection Anaesth Intensive Care, 41 (2013), p. 431

22 R.S. Sinatra, F.B. Sevarino, D. Paige Patient-controlled analgesia with sufentanil: a comparison of two different methods of administration J Clin Anesth, 8 (1996), pp. 123-129

23 A.S. Ammar, K.M. Mahmoud Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: a prospective randomized controlled trial Saudi J Anaesth, 6 (2012), pp. 109-114

24 B. Bisui, S. Samanta, S. Ghoshmaulik, et al. Effect of locally administered dexmedetomidine as adjuvant to levobupivacaine in supraclavicular brachial plexus block: double-blind controlled study Anesth Essays Res, 11 (2017), pp. 981-986

25 W.-S. He, Z. Liu, Z.-Y. Wu, et al. The effect of dexmedetomidine in coracoid approach brachial plexus block under dual stimulation Medicine, 97 (2018) e12240-e

26 M.J. Fredrickson, A. Abeysekera, R. White Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade Reg Anesth Pain Med, 37 (2012), pp. 495-501

27 P.S. Dharmarao, R. Holyachi Comparative study of the efficacy of dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block Turk J Anaesthesiol Reanim, 46 (2018), pp. 208-213

28 M. Kaur, R. Kaur, S. Kaur, et al. A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block Anesth Essays Res, 12 (2018), pp. 669-673

29 M. Gousheh, R. Akhondzadeh, M. Rashidi, et al. Comparison of dexmedetomidine and morphine as adjuvants to bupivacaine for epidural anesthesia in leg fracture surgery: a randomized clinical trial Anesthesiol Pain Med, 9 (2019) e91480-e

30 S.G. Chavan, A.R. Koshire, P. Panbude Effect of addition of fentanyl to local anesthetic in brachial plexus block on duration of analgesia Anesth Essays Res, 5 (2011), pp. 39-42

6098149ba9539539137440f2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections