Abstract
Background Peripheral nerve block has gained increased popularity owing to less postoperative pain and reduced need for postoperative analgesic drugs. The aim of the study was to compare the effect of ketamine and dexmedetomidine on the supraclavicular nerve block. Patients and methods A total of 75 adult patients undergoing elective operations of the elbow, forearm, wrist, or hand were randomly allocated into three groups of 25 patients each. Group K (ketamine group) received 40 ml 0.25% bupivacaine contain 1 mg/kg ketamine, group D (dexmedetomidine group) received 40 ml 0.25% bupivacaine contain 1 μg/kg dexmedetomidine, and group C (control group) received 40 ml 0.25% bupivacaine. The outcome measures included visual analog scale (0=no pain and 10 cm=the most severe pain), time to first analgesic request, and total dose of diclofenac analgesia given postoperatively. Results Patients in D and K groups had reduced visual analog scale scores than the C group, at all time points after surgery during the first 24 h, with more reduction in group D than K group (P Conclusion The addition of ketamine or dexmedetomidine in the ultrasound-guided supraclavicular brachial plexus block could improve the postoperative pain and need for analgesia. Therefore, we can consider the low-price readily available ketamine as a comparable adjuvant in brachial plexus block to some extent as dexmedetomidine.
Highlights
The supraclavicular brachial plexus block is a common anesthetic approach for upper limb surgery [1, 2]
Ketamine is a noncompetitive blocker of the N-methyl-D aspartate (NMDA) receptor it is used for premedication, sedation, induction, and maintenance of general anesthesia [12]
It has shown that adding ketamine to epidural bupivacaine or lidocaine could increase the duration of regional anesthesia and postoperative analgesia [13]
Summary
The supraclavicular brachial plexus block is a common anesthetic approach for upper limb surgery [1, 2]. It has shown that adding ketamine to epidural bupivacaine or lidocaine could increase the duration of regional anesthesia and postoperative analgesia [13] This effect can be mediated by interaction with a number of receptors like (NMDA) receptors, opioids and muscarinic receptors [14, 15]. In this present prospective double blind, randomized controlled study, we decide to compare the effects of 1ug/kg dexmedetomidine and 1mg/kg ketamine as adjuvants when added to local anesthetic in supraclavicular ultrasound guided block, Because adding ketamine to local anesthetics in brachial plexus block is still controversy, and the studies that examined the effects of dexmedetomidine as adjuvants in nerve blocks is much more than that of ketamine, in spite of low price and more availability of ketamine in our country than dexmedetomidine. The aim of the study was to compare the effect of ketamine and dexmedetomidine on the supraclavicular nerve block
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