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REGIONAL ANESTHESIA

The Enhancement of Sensory Blockade by Clonidine Selectively Added to Mepivacaine After Midhumeral Block

Henri Iskandar, MD, Emmanuel Guillaume, MD, Florence Dixmérias, MD, Bernard Binje, MD, Sylvain Rakotondriamihary, MD^*, Rodolphe Thiebaut, MD, and Pierre Maurette, MD^*

Clinique Chirurgicale Bordeaux-Mérignac, Mérignac, France; *DAR IIICHU Bordeaux; and ISPEDUniversité Bordeaux 2, Bordeaux, France

Address correspondence and reprint requests to Henri Iskandar, Clinique Chirurgicale Bordeaux-Mérignac, 9 Rue Jean-Moulin, 33700 Mérignac, France. Address e-mail to henri.iskandar{at}wanadoo.fr

Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. These patients were randomly allocated into two groups. The Control group (n = 28) received 10 mL of plain mepivacaine 1.5% for each nerve (median, musculocutaneous, ulnar, and radial). The Clonidine group (n = 30) received 10 mL of plain mepivacaine 1.5% for each nerve, but the median and musculocutaneous nerves also received a dose of 50 µg clonidine. One patient in the Control group and two patients in the Clonidine group with a failed block were therefore excluded from the analysis. The onset time of surgical anesthesia was recorded. The durations of sensory and motor blocks were checked every 15 min. The plasma mepivacaine concentration was analyzed from 10 patients in each group. Onset times for complete sensory block were similar between the two groups. Adding 50 µg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.

IMPLICATIONS: The addition of clonidine to local anesthetics prolongs the duration of sensory block in the nerves. Such a finding could have interesting clinical applications in ambulatory or planned surgery in which motor function is best maintained.

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