Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus

Background
Total intravenous anesthesia (TIVA) versus inhalational anesthesia was selected as the anesthetic method, in order to avoid the use of muscle relaxants during repair of brachial plexus injury. We designed this study to determine effect and efficacy of TIVA versus sevoflurane during repair of brachial plexus injury.
Methods
Sixty patients scheduled for repair of injured brachial plexus from January 2009 till December 2011 were enrolled in this prospective, single-blind, randomized study. They received either inhalation induction with sevoflurane and maintenance with sevoflurane and fentanyl (Group 1) or TIVA with, propofol and fentanyl (Group 2) or TIVA with dexmedetomidine and fentanyl (Group 3). Hemodynamics, intubation conditions, sedation score were assessed. Postoperative pain using visual analogue scale (VAS) was assessed. Discharge time, postoperative respiratory condition, any postoperative complications were recorded.
Results
All groups provided a similar significant reduction in hemodynamics compared with baseline values. Respiratory rate values of dexmedetomidine–fentanyl group were significantly higher than those in other groups. Oxygen saturation values of dexmedetomidine–fentanyl group were significantly higher than those of propofol–fentanyl group. Time to reach an Aldrete score of 10 was similar in all groups. Patients in sevoflurane–fentanyl group have significantly higher visual analogue score than other groups. Sedation score was higher in the dexmedetomidine–fentanyl group.
Conclusion
TIVA with propofol and with dexmedetomidine was more effective and favorable anesthesia than sevoflurane anesthesia during repair of brachial plexus injury.