Abstract
Introduction: Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. Bupivacainei is a longacting regional anaesthetic, efficacy of which is altered with the co-administration of additives. Aim: Aim of the study was to assess the efficacy of supraclavicular block with 0.5% bupivacaine compared to co-administration of additives and the associated complications. Method: Following ethical clearance and informed written consent, over 5 months from July 2020, 152 adult patients at Teaching Hospital Anuradhapura Sri Lanka undergoing upper limb surgeries were divided into 4 groups & prospectively followed-up. All groups received 0.5% of Bupivacaine while additives 2% Lidocaine, 8.4% sodium bicarbonate & 8 mg Dexamethasone were added to the other 3 groups. Sensory and Motor block onset time, duration of post-block analgesia, acute and late complications and patient satisfaction were noted. Data was analysed using descriptive statistics & ANOVA, using SPSS V.25. Results: Successful surgical anesthesia was achieved in all patients with 0 cases of long-term neurological complications with 94% patient satisfaction. The motor & sensory block onset time & post block analgesia duration respectively for Lidocaine (9.74 min, 9.74 min & 7.07 h), Bicarbonate (12.89 min, 16.32 min & 12.09 h), dexamethasone (19.34 min, 17.24 min & 20.87 h) & Bupivacaine were (20.39 min, 18.42 min & 13.15 h). Conclusion: The differences between bupivacaine and lidocaine groups for sensory & motor block onset times & between Bupivacaine & dexamethasone groups for post-block analgesia duration were statistically significant (p < 0.001). Supraclavicular block has minimal associated complications & additives Lidocaine shortens the onset of anaesthesia and the duration of analgesia while dexamethasone prolongs the duration of analgesia significantly.
Highlights
Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries
Supraclavicular block has minimal associated complications & additives Lidocaine shortens the onset of anaesthesia and the duration of analgesia while dexamethasone prolongs the duration of analgesia significantly
Forearm surgeries accounted for 73.03% of the surgeries performed under SCB and fracture Radius ± Ulnar open reduction and internal fixation (ORIF) was the leading surgery performed at 44.7%
Summary
Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. The motor & sensory block onset time & post block analgesia duration respectively for Lidocaine (9.74 min, 9.74 min & 7.07 h), Bicarbonate (12.89 min, 16.32 min & 12.09 h), dexamethasone (19.34 min, 17.24 min & 20.87 h) & Bupivacaine were (20.39 min, 18.42 min & 13.15 h). Conclusion: The differences between bupivacaine and lidocaine groups for sensory & motor block onset times & between Bupivacaine & dexamethasone groups for post-block analgesia duration were statistically significant (p < 0.001). Brachial plexus block is associated with excellent patient outcomes postoperatively for upper limb surgery, these benefits being; superior post-operative analgesia and recovery compared with that of general anaesthesia [7] [8] and opioid analgesia [9], and in providing similar quality of postoperative analgesia comparable to epidural analgesia [10]. Better postoperative pain control was observed in the supraclavicular brachial plexus block with reduced nausea and vomiting [11] [12]
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