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

Dexmedetomidine, is a selective alpha2-adrenoceptor agonist that is used as an adjuvant mixed with local anesthetics during regional anesthesia. This study was designed to test the efficacy of adding dexmedetomidine to bupivacaine during placement of infraclavicular brachial plexus blockade [ICB]. Sixty adult patients were divided into 2 equal groups of 30 subjects each. Patients in Group I received an ICB using 30 mL of 0.33% bupivacaine and Group II patients received 30 mL of 0.33% bupivacaine mixed with 0.75 micro g/kg of dexmedetomidine. The following brachial plexus nerve block parameters were assessed: block success rate, sensory onset time and duration, motor block onset time and duration, analgesic pain scores using the verbal rating scale [VRS] for pain, duration of analgesia, and amount of supplemental intravenous [IV] morphine required. There was a statistically significant shorter time to onset of sensory blockade [13.2 vs 19.4 min, P=0.003], longer duration of sensory block [179.4 vs 122.7 min, P=0.002], shorter onset time to achieve motor block [15.3 vs 22.2 min, P=0.003], longer duration of motor block [155.5 vs 105.7 min, P=0.002], lower VRS pain scores, prolonged analgesia [403 vs 233 min, P=0.002], and lower morphine rescue requirements for 48 h after surgery [4.9 [0-8.0] vs 13.6 mg [4.0-16.0] mg, P=0.005]. All patients recovered without evidence of sensory or motor deficit.: Adding dexmedetomidine to bupivacaine during the placement of an ICB provides: [1] enhancement of onset of sensory and motor blockade, [2] prolonged duration of analgesia, [3] increases duration of sensory and motor block, [4] yields lower VRS pain scores, and [5] reduces supplemental opioid requirements

Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: a prospective randomized controlled trial

Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane [TAP] block. Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% [control group, n=30] or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone "8 mg" [dexamethasone group, n=30]. The primary outcome was postoperative pain, as evaluated by visual analog scale [VAS] for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia [TFA], morphine consumption and the occurrence of nausea, vomiting or somnolence. The pain VAS score was significantly lower at the postoperative 2 h [4.9 vs. 28.1, P=0.01], 4 h [12.2 vs. 31.1, P=0.01] and 12 h [15.7 vs. 25.4, P=0.02]. Furthermore, TFA was significantly longer in the dexamethasone group [459.8 vs. 325.4 min, P=0.002], with lesser morphine requirements in the postoperative 48 h [4.9 vs. 21.2 mg, P=0.003] and lower incidence of nausea and vomiting [6 vs. 14, P=0.03]. No complications attributed to the block were recorded. Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting

Ultrasound-guided continuous infraclavicular brachial plexus block using bupivacaine alone or combined with adenosine for pain control in upper limb surgery

The infraclavicular brachial plexus block [ICB] is designed to deposit anesthetic high in the plexus, achieving anesthesia of the hand, forearm, elbow, and distal arm. Adenosine is a metabolic intermediate that is involved in nearly all aspects of cell function, including neurotransmission and signal transduction.This study was aimed to show whether addition of adenosine to bupivacaine in ultrasound-guided ICB had an analgesic effect. Sixty adult patients were divided into two equal groups, each group included 30 patients. Group I received infraclavicular bupivacaine 0.325% in a volume of 30 ml. Group II received 30 ml of 0.325% bupivacaine + 12 mg adenosine. The block was maintained with an infusion of 10 ml/h. The following parameters were assessed: Success rate, time of the sensory onset, motor block, visual analog scale [VAS], and amount of i.v. pethidine needed. This study showed an analgesic effect of infraclavicular adenosine as evidenced by a statistically significant shorter mean time of onset of the sensory block [16 vs. 20 min, P<0.05], lower mean VAS score over 48 h [1.7 vs. 2.7, P<0.05], longer mean time of first parenteral analgesic requirement [299 vs. 255 min, P<0.05], and lower mean total dose of pethidine needed over 48 h after surgery [25.5 vs. 56.6 mg, P<0.05]. All patients got successful infraclavicular block and recovered uneventfully without any sensory or motor deficit. Adenosine may provide valuable addition to the therapeutic options in anesthesia and pain management. Further research is required to figure out its exact role