A study of comparison of the efficacy of 0.5 percent Levobupivacaine with a combination of 0.5 percent Levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Abstract

Background: Axillary block is a regional anesthesia for surgeries at and below the elbow. Complications associated with peripheral blocks using blind approaches are addressed with advent of ultrasound guidance. Hyaluronidase drug works as a spreading factor. Combination of ultrasound guidance and hyaluronidase in addition to local anesthetics in peripheral blocks will increase efficacy and reduce complications. Objective: The objective of the study is to compare the efficacy of 0.5% Levobupivacaine with a combination of 0.5% Levobupivacaine and hyaluronidase in USG guided axillary brachial plexus block for forearm and hand surgeries with respect to: Onset of sensory and motor block, duration of sensory block and time to rescue analgesia. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 year who underwent elective upper limb surgeries in sridevi institute of medical sciences, tumkur from October 2017 to dec 2019 were included. Any patient with history of bleeding disorders, documented neuromuscular disorders, known allergy to Local anesthetics drugs, Psychiatric patients and if on anticoagulants were excluded from the study. Patients were alternately assigned to two groups Group A and Group B each containing 30 patients Patients undergoing Ultrasound guided Axillary Brachial plexus block with. GROUP A – 20 ml of 0.5% Levobupivacaine and Hyaluronidase 300 Units (15U/ml of local anesthetic) GROUP B – 20 ml of 0.5% Levobupivacaine. The patients were given Ultrasound guided Axillary brachial plexus block. onset of sensory blockade, onset of motor blockade, sensory block duration and time to rescue analgesia were compared. Results: The mean onset of sensory block in group A was 10.10±0.9 minutes and group B was 13.33±0.9 minutes. The mean onset of motor block in group A was 11.73±1.66 minutes and in group B was 14.23±1.45 minutes. The mean duration of sensory block in group A was 7.8±1.0 hours and in group B was 10.8±2.0 hours the mean time to rescue analgesia in group A was 9.9±1.3 hours and in group B was 12.2±2.0hours. Conclusion: In ultrasound guided axillary brachial plexus block using 0.5% levobupivacaine, addition hyaluronidase reduces onset of sensory and motor block time therefore shortens the total anaesthetic time before the operation. It also reduces the duration of post operative sensory block time and time to requirement of rescue analgesia.