A study to compare the haemodynamic stability and side effects when using 0.5 percent levobupivacaine vs combination of 0.5 percent levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Abstract

Background: One key component of enhanced recovery protocols is standardized analgesic and anesthetic regimens. Peripheral nerve blocks in particular help in enhanced recovery of the patient by the possibility of early mobilization of the patient. Local Anesthetics are drugs that prevent conduction of electrical impulses on the membranes of nerve and muscle. Adjutants are pharmacological drugs that when co- administered with local anaesthetic agents may improve speed of onset as well as the quality and duration of analgesia. Hyaluronidase drug works as a spreading factor by increasing tissue membrane permeability and reducing the viscosity. Objective: To find if there are any hemodynamic problems or any side effects when Levobupivacaine is used alone compared to Levobupivacaine when used with Hyaluronidase. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 years who underwent elective upper limb surgeries in Sridevi Institute of Medical Sciences, Tumkur from October 2017 to October 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. Hemodynamic parameters like pulse rate, non-invasive blood pressure, oxygen saturation was monitored. Mean arterial blood pressure (MAP) and pulse rate (PR), oxygen saturation was recorded before application of the block as well as immediately after block & 3 min intervals until the end of the operation. Any drop-in blood pressure more than 20% from the baseline signifies hypotension and was managed with Inj ephedrine 6 mg. Any decrease in pulse rate of less than 60 beats /min was managed with Inj. atropine 0.6mg. Any other complication other than this was noted. Results: Mean pulse rate was similar in both groups with Group A 81.87 and Group B 81.43. Mean arterial pressure between 2 groups was also similar MAP of Group A 105.3 and Group B 105.07. Conclusion: No significant hemodynamic changes were noted between both the groups. Hyaluronidase used as adjuvants along with local anaesthetics to improve the quality of block has no adverse effect on the hemodynamics, unlike other agents (adrenaline, dexmeditomidine, clonidine). It has a good safety profile.