Comparative study between ketamine-bupivacaine versus bupivacaine with intravenous ketamine infusion in supraclavicular brachial plexus block during upper limb surgeries

Abstract

Background Theb only drawback of using local anesthetics alone for supraclavicular brachial plexus block is that postoperative analgesia lasts for a shorter period. To block brachial plexus quickly and completely, different adjuvants, including opioids, dexmedetomidine, dexamethasone, midazolam, and ketamine, had been used with local anesthetics. Aim of the study was to compare the efficacy of adding ketamine to bupivacaine versus intravenous ketamine infusion with supraclavicular brachial plexus. Methods Sixty studied cases planned to undergo unilateral elective upper limb surgeries using ultrasound-guided supraclavicular brachial plexus block were separated into two groups: group 1: 20 ml bupivacaine 0.5% plus ketamine (1 mg/kg) with a maximum dose of 100 mg; (the total volume is 30 ml), with the infusion of 100 ml normal saline at a rate of 100 ml/h and group 2: 20 ml bupivacaine (0.5%) plus 10 ml saline; (the total volume is 30 ml) with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline at a rate of 100 ml/h, that was stopped 5 min before the end of surgery. Results Visual Analog Scale (VAS), heart rate and mean arterial pressure were significantly lower at 12 h postoperatively in group 1. The onset of sensory, motor block, duration of sensory and motor block were significantly lower in group 1 compared with group 2. The time of first rescue analgesia was significantly delayed in group 1 compared with group 2. Total ketorolac requirements were significantly lower in group 1. Conclusions Using ketamine bupivacaine in supraclavicular brachial plexus block in upper limb surgeries is effective in improving the onset of brachial plexus block and prolonging the time of brachial plexus block with no hemodynamic changes.