TO STUDY THE EFFECT OF DEXAMETHASONE AS AN ADJUVANT TO LOCAL ANAESTHETICS IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

BackgroundThere is an increase in use of regional anaesthetic techniques in various surgeries.Steroids have anti inflammatory and analgesic properties. Hence , we decided to study the efficacy ofdexamethasone as an adjuvant to local anaesthetic agents in supraclavicular brachial plexus block vialandmark approach for upper limb orthopaedic surgeries.Materials and MethodsAfter ethical clearance, and informed written consent, this prospective randomised controlled clinical studywas carried out in 50 patients, aged 18-50 years, ASA grade I or II, scheduled for elective or emergencyorthopaedic upper limb surgeries.Patients were randomly divided into two groups,Group A- received Inj. Bupivacaine 0.5% 10 ml, Inj. Lignocaine + Adrenaline (1.5%) 20 ml and Inj..Normal saline (0.9%) 2 mlGroup B- received Inj. Bupivacaine 0.5% 10 ml, Inj. Lignocaine + Adrenaline (1.5%) 20 ml and Inj.Dexamethasone (8 mg) 2 mlAfter confirming complete motor and sensory blockade, surgery was commenced.VAS score was recorded for 18 hours postoperatively where 0 equals no pain and 10 as worst possible pain.Results-● The onset of sensory and motor block was significantly faster in patients who receivedcombination of local anaesthetic and dexamethasone.● The duration of motor and sensory block in dexamethasone group was significantly higher thancontrol group.● There was no significant difference in the hemodynamics found between the two groupsperioperatively.● The duration of post operative analgesia was prolonged in dexamethasone group as compared tocontrol group.● Postoperatively, no complications were observed in any group.ConclusionThe addition of dexamethasone to local anaesthetics in supraclavicular approach of brachial plexus blockproduces adequate anaesthesia with following advantage.• Dexamethasone hastens the time of onset of sensory and motor blockade.• It prolongs the duration of sensory and motor blockade.• It prolongs the duration of postoperative analgesia.• Dexamethasone provides stable haemodynamics without any unwanted side effects in perioperative

Efficacy of Potassium Chloride 0.2 mmol as Adjuvant to 0.5% Ropivacaine versus Plain Ropivacaine 0.5% in Supraclavicular Brachial Plexus Block

Background: Brachial plexus block is one of the most common regional anesthetic techniques used for upper limb surgeries.Various adjuvants have been tried for prolonging the duration of post-operative analgesia and also to enhance the quality ofblock. We aimed to study the effects of the addition of potassium chloride to ropivacaine in supraclavicular brachial plexusblock compared to plain ropivacaine.Materials and Methods: This prospective, randomized, double-blind, and controlled study includes 80 adult patients agedbetween 20 and 60 years with ASA Grade I and II scheduled for upper limb surgeries. These patients were randomly allocatedinto two groups of 40 each. The patients in the group I/non-KCL group received 30 ml of 0.5 % ropivacaine along with 1 mlnormal saline (control group). Group II/KCL group received 30 ml of 0.5% ropivacaine along with 0.2 mmol (0.1 ml) of potassiumchloride (prepared by adding 0.1 ml of potassium chloride diluted with normal saline to make a volume of 1 ml) (study group).The onset, duration of sensory and motor blockade, quality of sensory and motor blockade, and the duration of post-operativeanalgesia were compared between both the groups.Results: The onset of sensory and motor blockade was earlier in Group II/ study group when compared to plain ropivacainegroup/Group I and was statistically significant with a P < 0.05. The mean duration of sensory and motor blockade was prolongedin Group II with enhanced quality of analgesia compared to Group I.Conclusion: In our study, it concludes that the addition of potassium chloride as an adjuvant to ropivacaine had a significantclinical advantage over plain ropivacaine on the onset, duration, quality of sensory and motor blockade, and post-operativeanalgesia in supraclavicular brachial plexus block.

The Effect of Single Point and Two Point Technique for Ultrasound Guided Supraclavicular Brachial Plexus Block in Patients Undergoing Elbow, Forearm and Wrist Surgeries- A Prospective Observational Study

Use of ultrasound for brachial plexus block has improved the precision of drug deposition around the plexus and hence the quality of the block. But there has been debate whether single point technique or double point technique is superior. Our aim was to compare the two techniques for the onset, completeness and quality of the block.METHODSA prospective observational study was designed. 140 patients were equally divided into Group A and Group B containing 70 posted for elbow, forearm and wrist surgery. A drug solution of 30 ml was prepared using Ropivacaine 0.75% 15ml + Lignocaine 2% with adrenaline 10 ml + 5ml of normal saline. Group A received 30ml of drug at the lower end of brachial plexus at 7 O’clock position. Group B received 15 ml of drug at site mentioned above and 15 ml was given at the upper part of brachial plexus at 11 O’clock position. Parameters noted were time taken for giving block, onset and completeness of sensory and motor block, encircle time, total duration of block. Unpaired student t test used for comparing quantitative variables and Chi-square test for qualitative variables. p < 0.05 was considered statistically significant.RESULTSThe time required for giving the block was more in Group B (198.57 ±19.56 sec) compared to Group A (151.53 ± 14.37 sec) but the encircle time in Group B (16 ± 3.32 min) was lesser than Group A (19.01 ± 3.6 min). The time of onset and completion of sensory and motor block for musculocutaneous, radial, ulnar and median nerve was faster in Group B compared to Group A. Duration of block in Group A was 367 ± 50.49 minutes, whereas in group B 388 ± 49.98 minutes.CONCLUSIONSIn ultrasound guided brachial plexus block, even though both techniques have satisfactory results, double point technique is superior to single point technique in terms of onset, completeness and duration of the block but in terms of simplicity in technicality single point technique has the upper hand.

A Study of Supraclavicular Brachial Plexus Block by Paresthesia Technique Success Rate and Complications: An Hospital Based Study

Background: The advantage of regional anaesthesia overgeneral anaesthesia are many and well documented. Brachialplexus can be blocked by various methods includingparesthesia technique, nerve stimulation technique and ultrasound guided. The present study was undertaken forassessing time taken to perform block, Successful blockade,complication of supraclavicular brachial plexus block byparesthesia technique.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with aim of assessing success rateand Complications of brachial plexus block. A total of 100patients were enrolled in the present study. Ethical approvalwas obtained from institutional ethical committee and writtenconsent was obtained from all the patients after explaining indetail of the entire research process. Complete demographicdetails of all the patients were obtained. All the results wererecorded in Microsoft excel sheet and were analyzed by SPSSsoftware.Results: Mean time to perform block was 5.35 minutes andsuccesfull blockade in 92% patients, in 6% patient’s partialblockade and in 2% patient’s complete failure of block.Incidence of complications were vessels puncture 8 % patientsand pneumothorax 1% patients.Conclusion: Supraclavicular brachial plexus block byparesthesia technique is an easy and relatively safe procedurefor the upper limb surgeries below mid shaft of humerus withfew complications and provide good post-operative analgesia.

Buprenorphine with Local Anaesthetic Combination in Supraclavicular Brachial Plexus Block Produced Prolonged Post-operative Analgesia Compared to Butorphanol with Local Anaesthetic: A Prospective, Randomized, Comparative Study

Background: Supraclavicular approach for brachial plexus block offers an alternative anesthesia for upper extremity surgery.Addition of opioid agents in local anesthetic solutions for prolongation of analgesia through brachial plexus block has beenvery effective in controlling post-operative pain. The time to request for the 1st dose of rescue analgesia can be prolonged byadding buprenorphine or butorphanol in local anesthetic solutions.Methodology: After institutional ethical committee approval, 60 American Society of Anesthesiologists I/II patients wererandomized for this study. They belong to either gender, aged between 18 and 55 years of age. Patients who required brachialplexus block through supraclavicular approach were included and the study drugs were administered according to groupallocation into Group I and Group II. Sensory and motor block characteristics were monitored and recorded in all patients,complications as well. Hemodynamic monitoring was done every 5 min interval in the intraoperative period and every 15 minintervals in the post-operative period. Patients were administered rescue analgesia postoperatively when visual analog scale(VAS) scores were ≥4. Data were analyzed statistically.Results: Onset time to sensory block was 3.1 (1.1) min in Group I and 4.9 (1) min in Group II, and there was statistically significantdifference between groups (P < 0.0001). Onset time to motor block was 5.4 (1.3) min in Group I and 9.3 (1.5) min in Group II,and the difference between groups was found to be significant statistically (P < 0.0001). The time to 1st request of analgesiawas found to be statistically significantly between I and II groups (354.8 [55.6] vs. 448.3 [34.4] min, P < 0.0001), respectively.Conclusion: Both buprenorphine and butorphanol produced effective analgesia in combination with local anesthetics withoutsignificant side effects, but buprenorphine produced prolonged analgesia when compared to butorphanol.

Effects of Dexamethasone and Ondansetron as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Blocks

Background Th supraclavicular brachial plexus block (SCBPB) exhibits a good anesthetic and analgesic effect to the upper extremity below the shoulder and reduces the need for opioid consumption. Among many medications, dexamethasone and ondansetron had been used as effective adjuvants to the local anesthetics in BPB. Aim: to compare the block characteristics with dexamethasone versus ondansetron as adjuvant to bupivacaine hydrochloride (BPV) in SCBPB. Materials and methods: 75 patients were allocated and divided into three equal groups. Combined ultrasound and nerve stimulation (CUSNS) - guided SCBPB had been done. Control group (C) received thirty ml of 0,5% bupivacaine with 2 ml of normal saline. Ondansetron group (O) received thirty l of 0.5% bupivacaine with 2 ml of 4 mg of ondasetron. In dexamethasone group (D), patient received thirty ml of 0.5% BPV plus 2 ml of 8 mg dexamethasone. Results: A prolonged effect of both sensory and motor block were observed in both group D and group O (more significant in D) than group C. Total dose of analgesic (tramadol in mgs in 24 hours) was obviously reduced in group D and group O than group C. Conclusion: Dexamethasone had better effects on sensory and motor block duration in comparison with ondansetron. The first time to analgesic request in dexamethasone group was longer than ondansetron group (AU)

Comparative Study of Dexmedetomidine versus Dexamethasone as an adjuvant for supraclavicular brachial plexus block

Introduction: Brachial plexus block is the most preferred anaesthetic technique for upper limb surgeries. Adding adjuvant to local anaesthetics for achial plexus block may enhance the duration and quality of analgesia and also to decrease the dose of postoperative opioid analgesic. Aims and Objectives: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine when added as adjuvant during supraclavicular achial plexus blocks (BPB) in respect to the onset and duration of sensory and motor block along with duration of analgesia. Methods: Sixty ASA physical status I-II patients of age group between 20 to 60 years with elective forearm and hand surgery under achial plexus blocks were randomly allocated into two equal groups in a randomised double blind fashion. Group DM (n = 30), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr + 1 ml of Dexmedetomidine (50mcg) + 1ml distilled water, making a total of 32 ml and another Group DX (n = 25), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr. + 2ml of Dexamethasone (8 mg). A nerve stimulation technique was used in all patients. The onset time and duration of sensory and motor blocks, quality of intraoperative analgesia and duration of analgesia were assessed. Results: The time of onset of sensory and motor block was significantly less in group DM as compared to group DX (P ＜ 0.05). The duration of the sensory and motor block as well as duration of post operative analgesia was significantly more in group DM as compared with group DX (P＜0.05), but there was no statistically significant difference between both the groups with respect to the heart rate, mean arterial pressure and spo2. Conclusions: Dexmedetomidine 50 g was more effective than dexamethasone 8 mg in extending the duration of supraclavicular achial plexus block and prolonging the duration of post operative analgesia and it also significantly decreases the onset time of block.

Efficacy Of Nalbuphine And Magnesium Sulfate With Ropivacaine For Quality Of Supraclavicular Brachial Plexus Block And Post-Operative Analgesia

Background: Adequate post-operative analgesia is the prime duty of anesthesiologist and several adjuvants have been usedalong with local anesthetics to prolong the duration of brachial plexus block. The present study aimed to compare the effect ofnalbuphine and magnesium sulfate as an adjuvant to ropivacaine and ropivacaine alone in nerve stimulator guided supraclavicularbrachial plexus block in patients scheduled for orthopedic upper limb surgeries.Materials and Methods: A total of 90 patients of in the age group of 20–65 years of either sex of the American Society ofAnesthesiologists Grade I and II were divided into three groups of 30 each. Group R received 30 ml of 0.75% ropivacaine alone,Group RM received 30 ml of 0.75% ropivacaine plus 150 mg of magnesium sulfate, and Group RN received 30 ml of 0.75%ropivacaine plus 20 mg of nalbuphine. All the groups were compared with respect to onset and duration of sensory and motorblockade, post-operative analgesia, need for rescue analgesia, hemodynamics, and side effects.Results: Onset of sensory and motor block was earliest in Group RN and was highly significant (P < 0.001) when compared toGroup R and Group RM. Mean duration of post-operative analgesia was 8.70 ± 1.18 h in Group R, 11.73 ± 1.23 h in Group RM,and 14.40 ± 1.25 in Group RN. Duration of sensory and motor block and post-operative analgesia were significantly prolonged(P < 0.001) both in Group RM and Group RN when compared to Group R.Conclusion: Both nalbuphine and magnesium sulfate are effective adjuvant as compared to ropivacaine alone as they prolong theduration of block as well as post-operative analgesia when used for supraclavicular brachial plexus block. However, nalbuphinehas proven to be a better adjuvant as compared to magnesium sulfate as it also results in earlier onset of sensory and motorblock and better patient and surgeon satisfaction scores.

Comparison Of Dexmedetomidine And Clonidine As An Adjuvant To Local Anaesthesia (BUPIVACAINE) In Supraclavicular Brachial Plexus Block

BACKGROUND: The study was done to compare the efficacy of injection dexmedetomidine versus injection clonidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block in adult patients. MATERIALS AND METHODS: 60 adult patients of ASA grade I/II, posted for various elective upper limb surgeries were divided into two groups Group C and Group D.Group C patients received Inj. Bupivacaine 0.5% 20 ml + Inj. Clonidine 1µg/kg and Group D patients received Inj. Bupivacaine 0.5% 20 ml + Inj. Dexmedetomedine 1µg/kg, in supraclavicular brachial plexus block. Onset and recovery time of sensory and motor block, duration of analgesia,hemodynamic variables ,sedation and complications were studied. RESULTS: Mean onset time of sensory block and motor block in Group D was significantly lower than Group C. Mean duration of sensory block and motor block was longer in Group D as compared to Group C. Mean duration of analgesia was significantly longer in Group D.There were no any significant incidents of any complications. CONCLUSION: Dexmedetomidine prolongs the duration of sensory and motor block, duration of analgesia, shortens the onset time for sensory and motor block as compared to clonidine when used as an adjuvant to local anaesthetic (bupivacaine) in supraclavicular brachial plexus block

Minimum Effective Volume Of A Combination Of Bupivacaine And Lignocaine For Supraclavicular Brachial Plexus Block Using Ultrasound Guided Technique

Background: To determine the effective volume of a combination of bupivacaine and lignocaine for supraclavicular achial plexus block using ultrasonography (USG). Methods: This study is an intervention study to determine the minimum effective volume of a drug combination. The principle statistical method applied in this study is Staircase Up-down method as described by Dixon and Massey.([i]) Results: By using the log transformation of the data of required volume and outcome as successful or unsuccessful we have calculated EV 50 = 11ml and EV 90 = 14ml. Conclusion: Minimum Effective Volume in 90% individuals (MEV 90) for a combination of 0.25% bupivacaine and 1% lignocaine for ultrasound guided achial plexus block via supraclavicular approach is 14ml.

Comparative study between dexamethasone and dexmedetomidine in supraclavicular block

Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an ?-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine.Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50?g of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded.Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups.Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.

Efficacy of Phenylephrine As An Adjuvant To BupivacaineIn Supraclavicular Brachial Plexus Block – A Prospective, Randomised Study

Background: Several adjuncts have been studied to potentiate the efficacy of local anaesthetic agents that increase the duration of analgesia, in peripheral nerve blocks, but the results have often been debated and counter debated. Phenylephrine has been studied intrathecally as an adjuvant and has been found to potentiate the effect of local anaesthetic agents. The present study was undertaken with a purpose to assess the efficacy of phenylephrine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Methods: A prospective, randomised, double blinded study was undertaken which included 40 ASA I or II patients, aged 18-60 years, ≥60 kg, scheduled for upper limb surgery under supraclavicular brachial plexus block. Patients were randomly divided into two groups of 20 each. Group S patients received 30 ml, 0.5% bupivacaine with 0.15 ml of saline and Group P patients received 30 ml, 0.5% bupivacaine with 0.15 ml (equivalent to 150 μg) of phenylephrine. Onset and duration of sensory and motor block, haemodynamic parameters, pain score, analgesia requirement and complications, if any, were recorded. Results: The total duration of sensory and motor block was significantly increased in group P, as compared to group S (p≤0.05). Pain scores were significantly lower and rescue analgesia demand was also significantly low in group P, in comparison to group S (p≤0.05). Demographic variables and haemodynamic parameters were comparable in both the groups. No major complications were seen. Conclusion: Phenylephrine (150 μg) when used as an adjuvant to 30 ml, 0.5% bupivacaine, in supraclavicular brachial plexus block, prolongs the duration of both the sensory and motor block thus enhances analgesia, decreases the rescue analgesic requirement and does not cause any adverse effects.

Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block

Introduction: Brachial plexus block is sole anesthesia for upper limb surgeries. Several techniques have been used to prolong the duration of regional anesthesia. The aim of the study: To compare the effectiveness of Clonidine as adjuvants to Ropivacaine in supraclavicular Brachial plexus block for prolonging the duration of motor blockade and prolonging the duration of analgesia. Materials and methods: 60 Patients of ASA grade I and II undergoing upper limb surgeries were randomly assigned into two groups R and RC. Surgery was done under the subclavian perivascular approach of supraclavicular brachial plexus block. The patients in group R received 25 ml at 0.75% Ropivacaine with 1 ml Normal saline. In a group RC received 25 ml at 0.75% Ropivacaine and 1 ml of (150 micrograms) clonidine. Parameters observed were a time of onset at the sensory block and motor block, duration of motor blockade, and sensory blockade, duration of postoperative analgesia, sedation score and side effects. Results: Addition of clonidine to Ropivacaine shows early onset of motor blockade compared to Ropivacaine alone. Addition of clonidine to local anesthetic solution significantly prolongs the duration of postoperative analgesia by 276 minutes compared to Ropivacaine alone. Addition of clonidine to Ropivacaine increased the duration of motor blockade by 132 minutes compared to Ropivacaine alone. S. Arul Rajan, N. Sathyan, T. Murugan. Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block. IAIM, 2018; 5(5): 33-37. Page 34 Conclusion: The addition of clonidine to the local anesthetic in supraclavicular brachial plexus produces the early onset of sensory and motor blockade and prolongs the duration of both sensory and motor blockade and postoperative analgesia, when compared to Ropivacaine alone.

Comparative study of lateral approach and subclavian perivascular approach of supraclavicular brachial plexus block using the peripheral nerve stimulators

Introduction: Supraclavicular Brachial plexus block is commonly used for upper limb surgeries. Supraclavicular block described as spinal of the arm because of the dense motor and sensory blocked below mid humerus. Advantages of the supraclavicular block are potent intraoperative and postoperative analgesia, reduction in stress response, reduction in opioid requirements and general anesthesia-related side effects. The Aim of the study: To evaluate the success rate as well as the quality of blockade and clinical efficacy of the Lateral approach compared with the Subclavian Perivascular approach of brachial plexus block for upper limb surgeries and both approach guided by peripheral nerve stimulators. Materials and methods: Sixty patients of ASA grade I and II of either sex undergoing upper limb surgeries were randomly allocated into two groups I and II. Each group comprises of 30 patients. Surgery was done under the Lateral approach of Brachial plexus Block in group I and under the subclavian perivascular approach of Brachial plexus block in group II. Results: Time to perform the block was shorter, Number of attempts was less and complications were less by the Lateral approach when compared to subclavian Perivascular approach. Conclusion: Supraclavicular block of brachial plexus by Lateral approach provides an adequate sensory blockade and motor blockade, with less time to perform block and reduced number of S. Arul Rajan, M. Bhavani, T. Murugan. Comparative study of lateral approach and subclavian perivascular approach of supraclavicular brachial plexus block using the peripheral nerve stimulators. IAIM, 2018; 5(5): 57-62. Page 58 attempts and good tourniquet tolerance, and high success rate and fewer complications when compared to subclavian perivascular approach.

A clinical comparison between bupivacaine midazolam combination and bupivacaine plain in brachial plexus block by supraclavicular approach

Background: The study is to describe the efficacy of Midazolam when used with Bupivacaine as local anesthetic in Supraclavicular brachial plexus block. The focus will be on the onset and analgesic duration of nerve blocks along with any neurotoxic concerns or neuroprotective potential. Materials and methods: A prospective, randomised single blinded study was undertaken in 100 patients posted for upper limb surgeries under supraclavicular brachial plexus block and were assigned into 2 groups, each containing 50 patients.  Control group – Group B: received 30ml Bupivacaine 0.375%  Study group – Group BM: received 30ml of mixture of Bupivacaine 0.375% and Midazolam 0.05mg/kg. Results: The onset of sensory and motor block was significantly faster in group BM compare to Group B (p<0.05). Rescue analgesic requirements were significantly less in group BM compared to group B (P<0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period. Conclusion: Midazolam 0.05mg/kg when addded to 30ml of Bupivacaine 0.375% for supraclavicular brachial plexus block speeds the onset of sensory and motor blocks (P<0.05). The combination produces improved analgesia, resulting in a prolonged effect and reduced requirements for rescue analgesics.

Influence of different volumes of ropivacaine with the same solubility on diaphragmaticparalysis following ultrasound-guided supraclavicular brachial plexus block / 临床麻醉学杂志

Objective To investigate the effects of different volumes of ropivacaine with the same solubility in supraclavicular brachial plexus block(SCBPB) under ultrasound guidance on ipsilateral diaphragmaticparalysis.Methods Seventy two patients (32 males,40 females, aged 18-65 years, of ASA Ⅰ or Ⅱ, scheduled for the right upper limb fracture internal fixation removal were randomized into group A (0.375% ropivacaine 20 ml) and group B (0.375% ropivacaine 30 ml), 36 cases in each group.The onset and duration of sensory and motor block were observed as well as complication.Diaphragmatic excursion were evaluated by M type ultrasound before and 30 min after drug injection under eupnea and forced respiration through observing diaphragmatic excursion to study diaphragmatic paralysis.Results The onset time of sensory block and maintaining time of sensory block or motor block had no significant difference between the two groups.Compared with group A,the onset time of motor block in group B was significantly shorter (P<0.05).Twelve cases (33.3%) in group A and 22 cases (61.1%) in group B respectively showed complete or partial hemidiaphragmatic paralysis 30 min after drug injection.Compared with group A, the rate of diaphragmatic paralysis in group B was significantly higher (P<0.05).Conclusion Supraclavicular brachial plexus block under ultrasound guidance with 0.375% ropivacaine 20 ml or 30 ml both can provide excellent anesthetic effect.0.375% ropivacaine 20 ml is less likely to lead to diaphragmatic paralysis.

Dexmedetomidine as an adjuvant to levobupivacaine in ultrasound guided supraclavicular brachial plexus block.

Background: Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks. Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia. Material and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325%levobupivacaine + 1μg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded. Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p< 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups. Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.

Evaluation of effect of dexmeditomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block.

Background: Background & objectives :To study the effect of dexmeditomidine as an adjuvant to bupivacaine in brachial plexus block on onset and duration of sensory and motor block, duration of analgesia, level of sedation,perioperative hemodynamic parameters and complications. Methods: fourty patients of ASA Ι and ASA ΙΙ scheduled for upper limb surgery were included in double blind randomised comparison of inj. Dexmeditomidine and inj. Normal saline. We divided patients in two groups. Group A patients were given inj dexmeditomidine 50 microgm (0.5ml) and group B patients were given inj normal saline in brachial plexus block. We recorded time of onset and duration of sensory and motor block, level of sedation, duration of analgesia, hemodynamic changes and side effects in both groups. Results: mean time to onset of sensory block was 7.42±1.39 min in group A and 8.24± 1.35 min and that of motor block was 15.1± 2.6min in group A and 17.0± 2.9min in group B.Total duration of sensory block was 722.15±78.27min in group A and 360.62±61.7min in group B and that of motor block was 600.6± 54.46min in group A and 300.4± 54.26min in group B. Duration of analgesia was 970.36 ± 80.7 min in group A and 480±40.31 min in group B. Conclusion: addition of 50 microgm of inj dexmeditomidine to bupivacaine in brachial plexus block shortens onset and prolongs duration of sensory and motor block, prolongs duration of analgesia and decreases intraoperative requirement of sedatives.

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation / 대한마취과학회지

BACKGROUND: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. METHODS: One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery. RESULTS: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction. CONCLUSIONS: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

The Effect of the Addition of Fentanyl and Midazolam to Lidocaine in a Supraclavicular Brachial Plexus Block / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effects of fentanyl and midazolam when used as adjuvant in a supraclavicular brachial plexus block. METHODS: 100 adult patients with an ASA status of I-II that were scheduled to undergo upper extremity surgery performed under a supraclavicular brachial plexus block were prospectively evaluated in this study.The patients were randomly divided into 4 study groups:Group 1, which received 40 ml of 1.5% lidocaine, Group 2, which received 3 mg of midazolam with 40 ml of 1.5% lidocaine, Group 3, which received 100microgram of fentanyl with 40 ml of 1.5% lidocaine, and Group 4, which received 3 mg of midazolam and 100microgram of fentanyl with 40 ml of 1.5% lidocaine.The onset time, as well as the duration of analgesia and motor blocks, proportion of successful blocks, hemodynamic parameters, and adverse events were then noted. RESULTS: The incidence of successful block was higher in group 4 (92%) than in any other groups (68-72%) (P = 0.185). In addition, the mean duration of analgesia was longer in groups 2 and 4 (165 min and 175 min) than in groups 1 and 3 (114 min and 131 min) (P < 0.05).Furthermore, the mean duration of motor block was longer in groups 2 and 4 (169 min and 180 min) than in groups 1 and 3 (123 min and 126 min) (P < 0.05).No significant difference was observed in the onset time of the sensory block and motor block when the groups were compared. CONCLUSIONS: Although the addition of 3 mg of midazolam and 100microgram of fentanyl to lidocaine in a supraclavicular brachial plexus block does not affect the onset of sensory or motor block, it does prolong the duration of analgesia and motor block.