Adjuvant In Brachial Plexus Block Research Articles

Comparison of Dexmedetomidine and Fentanyl Added to Levobupivacaine in USG-guided Axillary Block for Upper Limb Surgeries: A Randomised Double-blinded Controlled Study

Introduction: Apart from general anaesthesia, brachial plexus block by the axillary approach is one of the reliable sole anaesthetic techniques for patients undergoing upper limb surgeries. In this study, levobupivacaine was chosen due to fewer adverse effects compared to Bupivacaine, and fewer studies were available for the axillary approach to brachial plexus block. Adjuvants were added to hasten the onset and also to prolong their analgesic effect. Aim: To compare the effect of Dexmedetomidine (D) 0.5 mcg/kg and Fentanyl (F) 0.5 mcg/kg when added to 0.5% Levobupivacaine (L) as an adjuvant in brachial plexus block by the axillary approach for upper limb surgeries. Materials and Methods: A randomised double-blind controlled study was carried out at the Department of Anaesthesiology, Sree Balaji Medical College, BIHER, Chennai, Tamil Nadu, India from January 2020 to October 2021 on 60 American Society of Anaesthesiologists (ASA) I and II patients of either sex posted for various types of upper limb surgeries. Subjects were divided into two equal groups by computer-generated randomisation. Group A received 0.5% levobupivacaine and dexmedetomidine 0.5 mcg/kg, and Group B received 0.5% levobupivacaine and Fentanyl 0.5 mcg/kg. Both patients and the evaluator were unaware of the type of adjuvants added to the local anaesthetic. The onset time, duration of sensory and Motor blockade were recorded. Haemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. The Mann-Whitney U test demonstrated variations in the onset and duration of sensory and motor blocks. Adverse effects, including nausea, vomiting, and hypotension, exhibited significant differences according to Fisher’s-exact test. Results: Age and weight distributions were comparable between groups (mean age: Group A=45.20 years, Group B=44.80 years; mean weight: Group A=74.13 kg, Group B=74.43 kg). Group A exhibited faster sensory and motor block onset times (sensory: Group A=6.20 minutes, Group B=8.63 minutes; motor: Group A=8.27 minutes, Group B=10.00 minutes), longer block durations (sensory: Group A=11.63 hours, Group B=9.53 hours; motor: Group A=9.67 hours, Group B=8.20 hours), and required the first rescue analgesic (Group A=12.57 hours, Group B=10.27 hours) compared to Group B (p<0.05). Similarly, the mean time for the first rescue analgesia for patients among these two groups was also statistically significant (p<0.05). Conclusion: The addition of 0.5 mcg/kg dexmedetomidine to 0.5% levobupivacaine in axillary block was more effective in prolonging the duration of blockade and providing adequate intraoperative analgesia when compared to 0.5 mcg/kg fentanyl with 0.5% levobupivacaine, without producing any adverse events.

A prospective, randomized, double blinded comparative study between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in supraclavicular brachial plexus block for post operative analgesia in upper limb surgery: Pentazocine as adjuvant in brachial plexus block

In upper limb surgery supraclavicular brachial plexus (SCBP) block with 0.5% bupivacaine is commonly used for anesthesia. To increase the duration of sensory block opioids are used along with bupivacaine, but data on the effect of pentazocine as adjuvant with bupivacaine in SCBP block is still lacking. The study aimed to compare the duration of postoperative analgesia, sensory and motor block between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in SCBP. Methods: The study was conducted on 60 consenting patients, posted for upper limb orthopedic surgery involving the forearm under SCBP block. Patients were randomly divided into two groups. Group B received 19 ml of 0.5 % bupivacaine with 1 ml of normal saline; Group BP received 19 ml of 0.5 % bupivacaine with 1 ml pentazocine (30 mg). Block characteristics, duration of postoperative analgesia, and side effects if any were recorded. Statistical analysis was done using the student t-test and Chi-square test for continuous and categorical variables respectively. Results: The onset of sensory (11.47 ± 1.57 vs. 16.8 ± 2.23 min) and motor (8.17 ± 1.14 vs. 13.9 ± 2.44 min) block was significantly faster in the BP group. Duration of sensory (392.33 ± 9.92 vs. 357.2 ± 8.76 min) and motor (379.27 ± 9.28 vs. 347.27 ± 9.13 min) block was also prolonged in group BP (p < 0.0001). Duration of postoperative analgesia was more (p < 0.0001) in the BP group (407.43 ± 10.46 vs 367.3 ± 8.74min). Conclusion: Pentazocine as an adjuvant with bupivacaine in SCBP block provides faster onset, prolonged duration of the block, and postoperative analgesia.

Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review.

Background Both dexamethasone and dexmedetomidine are commonly used local anaesthetic adjuvants in brachial plexus block to enhance the blocking effect. However, it is unclear which of the two drugs is more effective in a brachial plexus block. This article compares the effects of dexamethasone and dexmedetomidine combined with local anaesthetics in brachial plexus block through meta-analysis, availing information for current practice and future research. Methods We conducted a search of the PubMed, Embase, Cochrane Library, and Web of Science databases to identify studies investigating the effects of dexamethasone and dexmedetomidine combined with local anaesthetics on brachial plexus block. The databases were searched from their inception to October 2021. Clinical randomized controlled trials were included. Two researchers independently conducted literature screening. The Cochrane System Review Manual was adopted for literature quality evaluation, whereas Stata 14.0 software aided in the meta-analysis. The duration of analgesia was the primary outcome indicator; whereas, the secondary outcome indicators included the duration of sensory block and motor block. Results Seven articles were analysed, including 465 patients. Compared to the dexmedetomidine group, the dexamethasone group exhibited longer durations of analgesia (WMD = 111.29, 95% CI: 16.49–206.10, P = 0.021), sensory block (WMD = 173.20, 95% CI: 86.69–259.71, P < 0.0001), and motor block (WMD = 121.03, 95% CI: 12.87–229.20, P = 0.028). Conclusion The present meta-analysis results affirm that dexamethasone is a better local anaesthetic adjuvant in brachial plexus block that enhances the blocking effect. Nevertheless, the existing heterogeneity warrants additional large-scale, multicentre, high-quality randomized controlled trials in the future for further verification and to provide more reliable clinical evidence.

Ketamine versus dexmedetomidine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: a double-blind randomized clinical trial

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.

Comparison of different concentration of dexmedetomidine added to ropivacaine in ultrasound guided supraclavicular block for orthopedic forearm surgery-a prospective, randomized, comparative clinical study

There is no fix and ideal dose is known for dexmedetomidine as an adjuvant in brachial plexus block. So this study was performed to evaluate different doses of dexmedetomidine added to 0.5% ropivacaine, with the primary outcome of the duration of analgesia. Secondary outcomes included the effect on block characteristics, sedation, hemodynamics and adverse effects.Totally 60 adult patients were randomly allocated to two equal groups (n = 30) using computer generated randomization. Patients in Group RD50 received 24 ml 0.5% ropivacaine + 50 µg of dexmedetomidine and Group RD100 received  24 ml 0.5% ropivacaine + 100 µg of dexmedetomidine in ultrasonography guided supraclavicular block.The primary aim was the duration of analgesia and secondary aim were onset and duration of the sensorimotor blockade, hemodynamic variables, sedation score, and adverse effects The data were interpreted with the help of t-test and Chi-square test.In group RD50, the onset of both sensory and motor block was 8.18 ± 1.49 min and 14.11 ± 2.09 min, respectively, while in group RD100 it was 8.23 ± 1.41 min and 14.06 ± 2.44 min, respectively. The duration of analgesia was similar in both groups (862.32 ± 45.51 vs. 864.43 ± 44.02 min; P &amp;#62;.05). The occurrence of bradycardia was observed significantly greater in RD100 group patients.The addition of 100 µg dexmedetomidine to ropivacaine has similar effects on block characteristics and duration analgesia with a higher incidence of bradycardia as compare to 50 µg. 

Comparison of neurotoxicity of dexmedetomidine as an adjuvant in brachial plexus block in rats of different age

Dexmedetomidine is a local anesthetic adjuvant that exerts neuroprotective effects in addition to its sedative and analgesic properties. However, it is not clear whether dexmedetomidine causes any neurotoxicity in neonates. We injected dexmedetomidine alone or in combination with ropivacaine to induce brachial plexus block in rats of different age, corresponding to human neonate, childhood, adolescence and adulthood. We then examined pro-inflammatory cytokines and activated caspase 3 to determine the neurotoxicity effects. We found that high dose of dexmedetomidine significantly reduced IL-6 and TNF-α levels in all aged rat brachial plexus compared to saline treatment, and these levels are similar to that of control brachial plexus at postnatal day 14, 18 and adulthood. Caspase 3 level is not significantly different between dexmedetomidine and control group, except that it is higher in dexmedetomidine treated group at postnatal day 5. We found that this neurotoxicity effect of dexmedetomidine is only present at a high dose. Dexmedetomidine shows minimal neurotoxicity in neonate rats during brachial plexus block when moderate doses are administered. This observation warrants more detailed clinical studies to determine the safety of using dexmedetomidine for brachial plexus block in infant or early childhood patients.

Perineural versus intravenous clonidine as an adjuvant to Bupivacaine in supraclavicular Brachial plexus block

BackgroundClonidine has been used as an adjuvant in Brachial plexus block (BPB) to enhance its quality and duration. However, whether, clonidine in BPB acts perineurally or via systemic absorption is not entirely clear.MethodsNinety-three patients of either sex, ASA I and II, aged 18–70 years, undergoing lower end humerus fracture fixation were included in the study. Patients were randomized into 3 groups. All the patients received brachial plexus block using nerve stimulator with 28 ml 0.5% Bupivacaine and 2 ml of NS/NS with clonidine. In the first group (Bc) 2 mcg/kg of clonidine was added to the anaesthesia solution and 10 ml of NS was injected intravenously; second group (Bivc) received clonidine 2 mcg/kg diluted up to 10 ml by intravenous route with 28 ml of 0.5% Bupivacaine and 2 ml of NS in the block; third group (B) received 28 ml of 0.5% Bupivacaine with 2 ml of NS in the block and 10 ml of NS intravenously, as placebo. Onset and duration of sensorimotor block, hemodynamic variables, duration of analgesia, level of sedation and adverse effects were noted.ResultsOnset of sensory blockade was faster in group Bc (7 ± 0.720 min) compared to group B (11.46 ± 1.138 min) and Bivc (11.46 ± 1.170 min) (p < 0.001). Onset of motor block was faster in group Bc (16.43 ± 1.136 min) compared to group B (22.75 ± 1.456 min) and Bivc (22.25 ± 1.295 min) (p < 0.001). The mean durations of analgesia were recorded as 1160.71 ± 53.259 min in group Bc, 454.64 ± 14.07 min in Group Bivc and 442.50 ± 18.634 min in group B.ConclusionAddition of clonidine 2mcg/kg to 28 ml of 0.5% bupivacaine in brachial plexus blocks results in a faster onset, increased duration of block and longer postoperative pain relief when compared to bupivacaine alone. These advantages are not observed when the same dose of clonidine is injected intravenously.

A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasound-guided supraclavicular brachial plexus block.

Background and Aim:Magnesium sulphate (MgSO4) has been used as an adjuvant in brachial plexus block with encouraging results; however, there is no consensus regarding its optimal dose. Thereby, we compared the efficacy of two doses of MgSO4 as an adjuvant in ultrasound (USG) guided supraclavicular brachial plexus block.Methods:Ninety patients, aged 20–60 years, belonging to American Society of Anesthesiologists physical status 1 or 2, were given USG-guided supraclavicular block. Group B (n = 30) received 20 ml of 0.5%bupivacaine + 5 ml normal saline (NS), Group BM0.5(n = 30) received 20 ml of 0.5%bupivacaine + 3.75 ml NS and 125 mg MgSO4 (1.25 ml) and Group BM1(n = 30) received 20 ml of 0.5%bupivacaine + 2.5 ml NS and 250 mg MgSO4 (2.5 ml). The primary outcome of study was the duration of post-operative analgesia. The normally distributed data were analysed using analysis of variance and categorical data analysed using Chi-square test.Results:Duration of post-operative analgesia was prolonged in Groups BM1 and BM0.5 (665.13 ± 97.874, 475.10 ± 53.294) min respectively as compared to Group B (272.03 ± 40.404 min: P = 0.00). The onset times of sensory and motor block were shorter in Group BM1 (5.17 ± 2.2 min) as compared to Groups BM0.5 and B (8.9 ± 2.3 and 17.7 ± 5.1 min: P = 0.00) respectively. Sensory and motor block durations were prolonged in Group BM1 as compared to BM0.5 and B (P = 0.00).Conclusions:MgSO4 as adjuvant in brachial plexus block increases the duration of post-operative analgesia. MgSO4 in the dose of 250mg has greater efficacy as compared to 125 mg.

A comparative study between ropivacaine 30 ml (0.75%) and ropivacaine 30 ml (0.75%) with clonidine 150 μg as an adjuvant in brachial plexus block through supraclavicular approach

Background: Ropivacaine is a novel alternative to bupivacaine with the less cardiovascular system and central nervous system toxicity. Clonidine, an alpha 2 agonist, may have benefited patients when it is injected at peripheral nerve sites with local anesthetic ropivacaine. Clonidine is second only to epinephrine as a useful adjuvant for brachial plexus blockade. Objective: A clinical study was carried out to compare the anesthetic effects of ropivacaine alone and clonidine as an adjuvant to ropivacaine in brachial plexus block for upper limb surgeries. Materials and Methods: A comparative, double-blind, prospective, randomized, clinical study was carried out on 60 patients of either sex of American Society of Anesthesiologist physical status I and II, with age group 25-65 years undergoing various orthopedic surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly allocated to either of the two groups of 30 each. Group-R: Injection ropivacaine 30 ml (0.75%) with 1 ml normal saline. Group-ropivacaine clonidine (RC): Iinjection ropivacaine 30 ml (0.75%) with injection clonidine 1 ml (150 μg). Heart rate, mean arterial pressure, onset and duration of motor and sensory blockade were observed during preoperative, intraoperative and postoperative period. At the end of the study, the data were analyzed using Chi-square test for qualitative data and Student t-test. P < 0.05 was considered significant and P < 0.01 was considered as highly significant. Results: Demographic and hemodynamic data were comparable. Onset of sensory and motor block was significantly earlier in Group-R. Duration of analgesia and motor blockade was prolonged in the RC group. Both groups were observed for the side-effects, which were not significant. Conclusions: Addition of clonidine 150 μm to ropivacaine 0.75% 30 ml delays the onset of sensory and motor blockade while prolongs the postoperative motor blockade and analgesia significantly without producing any clinical significant side-effects in brachial plexus block through supraclavicular approach.

Effects of Dexamethasone as a Local Anaesthetic Adjuvant for Brachial Plexus Block

Abstract Background Brachial plexus nerve blocks (BPBs) have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by the pharmacological duration and therapeutic index of local anaesthetics (LAs). Continuous catheter techniques, while effective can present management challenges. Off-label use of perineural dexamethasone as an LA adjuvant has been utilized to prolong single-injection techniques. The objectives of this systematic review and meta-analysis are to assess the contemporary literature and quantify the effects of dexamethasone on BPB. Methods The authors searched for randomized, placebo-controlled trials that compared BPB performed with LA alone with that performed with LA and perineural dexamethasone. Meta-analysis was performed using a random effects model with subgroup analysis stratified by LA (long vs intermediate). The primary outcome was duration of sensory block or analgesia; the secondary outcomes were motor block duration, opioid consumption, and BPB complications. Results Nine trials (801 patients) were included with 393 patients receiving dexamethasone (4–10 mg). Dexamethasone prolonged the analgesic duration for long-acting LA from 730 to 1306 min [mean difference 576 min, 95% confidence interval (CI) 522–631] and for intermediate from 168 to 343 min (mean 175, 95% CI 73–277). Motor block was prolonged from 664 to 1102 min (mean 438, 95% CI 89–787). The most recent trial demonstrated equivalent prolongation with perineural or systemic administration of dexamethasone compared with placebo. Conclusions Perineural administration of dexamethasone with LA prolongs BPB effects with no observed adverse events. The effects of systemic administration of dexamethasone on BPB must be investigated.

Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials

BackgroundBrachial plexus nerve blocks (BPBs) have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by the pharmacological duration and therapeutic index of local anaesthetics (LAs). Continuous catheter techniques, while effective can present management challenges. Off-label use of perineural dexamethasone as an LA adjuvant has been utilized to prolong single-injection techniques. The objectives of this systematic review and meta-analysis are to assess the contemporary literature and quantify the effects of dexamethasone on BPB. MethodsThe authors searched for randomized, placebo-controlled trials that compared BPB performed with LA alone with that performed with LA and perineural dexamethasone. Meta-analysis was performed using a random effects model with subgroup analysis stratified by LA (long vs intermediate). The primary outcome was duration of sensory block or analgesia; the secondary outcomes were motor block duration, opioid consumption, and BPB complications. ResultsNine trials (801 patients) were included with 393 patients receiving dexamethasone (4–10 mg). Dexamethasone prolonged the analgesic duration for long-acting LA from 730 to 1306 min [mean difference 576 min, 95% confidence interval (CI) 522–631] and for intermediate from 168 to 343 min (mean 175, 95% CI 73–277). Motor block was prolonged from 664 to 1102 min (mean 438, 95% CI 89–787). The most recent trial demonstrated equivalent prolongation with perineural or systemic administration of dexamethasone compared with placebo. ConclusionsPerineural administration of dexamethasone with LA prolongs BPB effects with no observed adverse events. The effects of systemic administration of dexamethasone on BPB must be investigated.

Use of Ketorolac as adjuvant in brachial plexus block with bupivacaine

Use of Ketorolac as adjuvant in brachial plexus block with bupivacaine

Use of methadone as adjuvant in brachial plexus block: a randomised prospective study

Use of methadone as adjuvant in brachial plexus block: a randomised prospective study

Use of methadone as adjuvant in brachial plexus block: a randomised prospective study

Use of methadone as adjuvant in brachial plexus block: a randomised prospective study