RESUMO
INTRODUCTION: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. SUBJECTS AND METHODS: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. RESULTS: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. CONCLUSION: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.
RESUMO
AIMS AND OBJECTIVES: The aim of this study is to compare the effects of intrathecal levobupivacaine with levobupivacaine and fentanyl in patients undergoing cesarean section. METHODS: Patients with American Society of Anesthesiologists Physical Status I and II scheduled for cesarean section under spinal anesthesia were randomly allocated with thirty patients each. Group L: levobupivacaine group - thirty patients (10 mg). Group F: levobupivacaine plus fentanyl group - thirty patients (7.5 mg + 12.5 µg). Hemodynamic monitoring, sensory and motor levels, and neonatal Apgar score were noted intraoperatively. The total duration of motor and sensory block, time for rescue analgesia was noted postoperatively. RESULTS: Prolonged duration of postoperative sensory and rescue analgesia was found in Group F - 112.97 ± 19.42, 231.26 ± 10.92 min as compared to Group L - 100.37 ± 10.64, 185.93 ± 11.09 min and duration of motor blockade was prolonged in Group L - 87.83 ± 15.04 min than Group F - 79.20 ± 8.93 min and P < 0.05 was found statistically significant. Apgar scores in both groups were comparable. CONCLUSION: Intrathecal levobupivacaine plus fentanyl prolonged duration of sensory block and rescue analgesia without prolonging motor block which could help in early ambulation.
