Comparison of the Efficacy of Clonidine with Levobupivacaine versus Levobupivacaine Alone in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background: The supraclavicular brachial plexus block is a safe, effective, and cost-efficient method of anesthesia. To extend its effects into the postoperative period and provide analgesia, adjuvants such as clonidine, dexamethasone, and adrenaline are often added. This study was conducted to compare the efficacy and safety of clonidine combined with levobupivacaine for supraclavicular brachial plexus blockade. Methods: A randomized single-blind controlled trial was conducted with 40 patients of ASA Grade I or II undergoing upper limb surgery. Group A (n = 20) received 30 ml of 0.5% levobupivacaine and 1 ml of normal saline through the supraclavicular approach for the brachial plexus block, while Group B (n = 20) received 30 ml of 0.5% levobupivacaine with 0.3 ml clonidine (50 µg), diluted with normal saline to make up the solution to 1 ml. Vital parameters were recorded 10 minutes before block placement and every 3 minutes afterward until the end of the procedure. The onset and duration of both sensory and motor blocks, as well as sedation scores, were recorded. All patients were monitored in the post-anesthesia care unit and received a tramadol injection of 100 mg IV in 100 ml of saline as soon as they reported pain as a rescue analgesic. The duration of analgesia was measured from the time of block placement until the administration of the rescue analgesic. Results: In Group B, the onset of motor and sensory blockades was faster. No statistically significant difference was observed in heart rate, blood pressure, and oxygen saturation between the groups. Sedation scores were higher in Group B, and postoperative analgesia lasted for 946.17 ± 137.99 minutes compared to 655 ± 159.39 minutes in Group A, which was statistically very significant (p < 0.0001). Conclusion: Our study concluded that levobupivacaine is an effective drug for supraclavicular brachial plexus block, providing a long duration of pain relief with minimal disturbances in hemodynamic variables. Adding 50 µg of clonidine as an adjuvant to levobupivacaine prolongs the duration of sensory and motor blocks while reducing the latency period.