USG Guided Infraclavicular Perineural Infusion of Bupivacaine with Additives Adenosine and Magnesium Sulphate Compared for Upper Limb Surgeries

Abstract

Background: Brachial plexus block has revolutionized the field of regional anesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without major complications. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Methods: 40 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/ hand divided into two groups A (n-20) and B (n-20) randomly. Group A - adenosine 6mgs with 28 ml 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 6mgs of adenosine (2ml) at a rate of 5ml/hr. Group B magnesium sulphate 75 mgs (in 2ml) with 28ml of 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 75mgs of magnesium sulphate (in 2ml) at a rate of 5ml/hr in USG guided placement of infraclavicular catheter. Results: Statistical analysis showed Group A had a faster onset time of sensory and motor block and faster recovery when compared to group B. Group A needed more rescue analgesia than group B. Though Group B had a higher incidence of sedation and vomiting than group A, it was not significant. Conclusion: Though the addition of adenosine and magnesium sulphate to bupivacaine as additive gives prolonged analgesia, magnesium sulphate exceeds adenosine in achieving prolonged postoperative analgesia and better pain score and may be a better choice than adenosine.