| Brachial plexus block (BPB) is one of the most commonly used anaesthetic techniques for upper limb surgeries. It can be done through various approaches, namely- supraclavicular, infraclavicular, interscalene, axillary, cervical and paravertebral. The narrowest part of the brachial plexus is located in the supraclavicular region and anaesthesia will be rapid, dense and predictable for the entire upper limb. USG guidance helps in the deposition of drug at the apt place, augments block success and avoids problems associated with conventional techniques like discomfort, nerve injury and high failure rates. Addition of adjuvants to local anaesthetics shortens the onset of sensory and motor block and prolongs the duration of block Dexmedetomidine is a d-isomer of medetomidine. It is a highly selective alpha-2 agonist, with 8 times more affinity than clonidine.3 Dexmedetomidine acts by presynaptic activation of alpha-2 receptors, thereby terminating pain signal by inhibiting noradrenaline release Dexamethasone is a synthetic corticosteroid, that is preferred due to its high anti-inflammatory properties. It is 25-30 times more potent than hydrocortisone with no mineralocorticoid activity. Steroid addition can prolong duration of block and produce earlier onset.The anti-inflammatory property due to inhibition of phospholipase A2 is responsible for the analgesic effect. Primary objectives: To compare dexmedetomidine and Dexamethasone as adjuvant to local anaesthetics in USG guided supraclavicular brachial plexus block in terms of: • The onset of sensory and motor blockade • The duration of sensory and motor blockade Secondary objectives: To compare dexmedetomidine and dexamethasone as adjuvant to local anaesthetics in USG guided supraclavicular brachial plexus block in terms of: • The total duration of analgesia • Quality of the block After approval from the Institutional Ethics Committee, participants satisfying the inclusion criteria will be enrolled after obtaining written informed consent. A pre-anaesthetic evaluation will be done a day prior to the surgery for elective surgeries. Patients will be shifted to the operation theatre. All the basal parameters will be recorded. USG guided supraclavicular Brachial plexus block will be administered to the patient by the consultant anaesthesiologist in-charge of the case and the blinded observer will acquire the data for the next 24 hours thereafter the patient will be grouped as per the combination of the drugs used. Supraclavicular brachial plexus block will be performed under all aseptic precautions using ultrasound equipped with a high frequency (6-13 MHz) linear probe. With the patient lying supine and head turned 45° contralateral, the site will be prepared and draped. Ultrasound transducer will be placed in the supraclavicular fossa in the coronal oblique plane to visualize brachial plexus in the transverse sectional view. Brachial plexus will be approached with a 25 G needle. The block needle will be inserted using the in-plane technique, from lateral-to-medial direction towards the brachial plexus and the study drug will be injected incrementally following negative aspiration to obtain a uniform spread around the brachial plexus. The following data will be collected in the intraoperative and the postoperative period:- DURATION OF ONSET OF SENSORY BLOCKADE: It is assessed along the dermatomal distribution of four nerves – musculocutaneous, median, ulnar and radial nerves using the ‘spirit swab method’. The onset of sensory is defined as the time interval between the LA administration and the achievement of complete loss of sensation along the dermatomal distribution of all four nerves DURATION OF SENSORY BLOCKADE: It is defined as the time interval between end of drug administration and complete resolution of anaesthesia in the dermatomal distribution of all 4 nerves (patient response score of 0) DURATION OF ONSET OF MOTOR BLOCKADE: It is assessed using the ‘modified Bromage scale for upper limb’ SCORE RESPONSE The onset of motor block is defined as the time interval between the LA administration and the achievement of complete loss of motor function (until Modified Bromage Scale score of 0). DURATION OF MOTOR BLOCKADE: It is defined as the time interval between end of drug administration and complete resolution of motor function (until Modified Bromage Scale score of 4). Secondary objectives: To compare dexmedetomidine and dexamethasone as adjuvant to local anaesthetics in USG guided supraclavicular brachial plexus block in terms of: • The total duration of analgesia • Quality of the block DURATION OF ANALGESIA: It is defined as the time interval between administration of drug and the first rescue analgesia. RESCUE ANALGESIA: When the post op NRS score reaches 4, rescue analgesic Tramadol injection 50 mg IV will be given. The post operative pain assessment will be stopped once the rescue analgesic is given. QUALITY OF BLOCK: This will be assessed by the attending Anaesthesiologist as excellent,good , moderate or unsuccessful |