Bupivacaine In Brachial Plexus Block Research Articles

A COMPARATIVE STUDY BETWEEN CLONIDINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN BRACHIAL PLEXUS BLOCK THROUGH USG-GUIDED AXILLARY APPROACH

Objective: To improve the quality of block in regional anaesthesia, several adjuvants are added to local anaesthetic drugs. The effects of clonidine and dexmedetomidine were compared with regard to the onset and duration of sensory and motor block as well as the length of analgesia when used as an adjuvant to bupivacaine in brachial plexus block by axillary approach.
 Objective: The present study was conducted to compare the onset time, duration and analgesic efficacy of clonidine vs dexmedetomidine when added as adjuvant to bupivacaine (0.5%) for USG guided brachial plexus by axillary approach.
 Methods: This is a prospective, randomized; comparative study conducted in elective unilateral upper limb forearm and hand surgeries. The study was conducted at Government General Hospital, Srikakulam, between March 2023 to September 2023 after obtaining permission from the Institutional Ethics Committee and from the patients. Group BC received 30 ml of 0.5% bupivacaine with Clonidine 1µg/kg (n=30) and Group BD received 30 ml of 0.5% bupivacaine with dexmedetomidine 1µg/kg (n = 30). The onset and duration of sensory and motor block total duration of analgesia were studied in both groups.
 Results: The mean time for onset of sensory block in Group BD was 4.7 min, which was lower than Group BC 8.47 min. The mean time for onset of motor block in Group BD was 9.63 min the mean time for total duration of sensory block in Group BD was 537.8 min. This was higher than the Group BC 319.1 min. The total duration of analgesia in Group BD was 666.27 min. This was higher than in Group BC 375.23 min. Bupivacaine dexmedetomidine group had better quality analgesia than the bupivacaine clonidine group.
 Conclusion: The addition of Dexmedetomidine (1μg/kg) to bupivacaine (0.5%) in brachial plexus block by USG-guided axillary approach results in a shorter onset time for sensory and motor blockade, prolongs the duration of sensory and motor blockade and also total duration of analgesia.

COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE VERSUS BUPIVACAINE WITH CLONIDINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

Objective: To compare the efficacy of clonidine with dexmedetomidine as an adjunct to bupivacaine in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Methods: This was a prospective comparative study conducted in the department of anesthesiology of a tertiary care medical institute. 80 patients undergoing various upper-limb surgeries were included in this study. Patients were divided into two groups on the basis of whether they received Clonidine (Group C) or Dexmedetomidine (Group D) as an adjuvant to Bupivacaine for supraclavicular block. The onset as well as duration of sensory and motor blockade, duration of analgesia, quality of anesthesia, hemodynamics, and adverse effects were compared between the two groups. p<0.05 was considered statistically significant. Results: The gender distribution of cases in Group C and Group D was found to be comparable, with no statistically significant difference. The mean age of patients in both groups was found to be comparable with no significant difference (p=0.5671). The most common types of surgeries in the studied cases were those of the lower radius and ulna (28.75%), followed by the lower humerus (21.25%), upper radius, and ulna (20%). The mean duration of sensory and motor block and duration of analgesia were found to be higher in group D as compared to group C, and the difference was found to be statistically highly significant (p<0.0001). The quality of anesthesia was better in patients who received dexmedetomidine as compared to those who received clonidine with Bupivacaine. Conclusion: Dexmedetomidine used as an adjuvant with bupivacaine for brachial plexus block is associated with prolonged duration of sensory as well as motor block and duration of analgesia as compared to when clonidine is used as an adjuvant. It is also associated with a better quality of anesthesia.

Comparison between Ropivacaine and Bupivacaine for Brachial Plexus Block by Supraclavicular Approach in Upper Limb Orthopaedic Surgeries

Comparison between Ropivacaine and Bupivacaine for Brachial Plexus Block by Supraclavicular Approach in Upper Limb Orthopaedic Surgeries

To compare the hemodynamic changes produced by the drug after the usage of Midazolam as an adjunct to bupivacaine in brachial plexus block

Introduction: Bupivacaine, a local anesthetic, in brachial plexus block produces highly efficient intraoperative anesthesia and also analgesia. This study was carried out to observe the effect of the addition of midazolam to local anesthetic in brachial plexus block in the intraoperative and post-operative period. Objective: To compare intraoperative and post-operative Hemodynamic changes (pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate) with bupivacaine alone and bupivacaine-midazolam combination. Methodology: A randomized clinical trial was conducted on 70 ASA-I or II adult patients undergoing upper limb surgeries (scheduled for forearm and hand surgery) under axillary brachial plexus block. Patients were randomly allocated into two groups of 35 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 µg·kg–1. Results: The mean (±SD) age of patients in Group A and B were 37.97± 13.73 years and 39.28± 14.19 years respectively. Hemodynamic variables (pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate) were recorded and compared using the student’s test (paired for intragroup and unpaired for intergroup comparison) and Chi-Square test. P-value <0.05 was taken to be statistically significant and <0.001 highly significant.

COMPARISON OF EFFICACY OF DEXMEDETOMIDINE VS CLONIDINE AS AN ADJUVANT TO BUPIVACAINE IN ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Background & Aims: Apha-2 agonists are combined with local anaesthetics to extend the duration of regional anaesthesia. We compared the effect of dexmedetomidine vs clonidine with bupivacaine with respect to duration of motor and sensory block and duration of analgesia in supraclavicular brachial block. Methods: Hundred patients scheduled for elective forearm and hand surgery were divided into two equal groups in a randomized double blind fashion. The patients received ultrasound guided supraclavicular brachial plexus block. In group C (n=50) 29ml of 0.5% bupivacaine plus 1mcg/kg of clonidine diluted to 1ml and in group D (n=50) 29ml of 0.5% bupivacine plus 1mcg/kg of dexmedetomidine diluted to 1ml was given. Onset and duration of motor and sensory block and duration of analgesia were recorded. Data analysis was done by SPSS version 22.0 software.Statistical signicance was dened as P<0.05. Result: The addition of 1μg/kg of dexmedetomidine to 29ml of bupivacaine (0.5%) produces a shorter onset time for sensory and motor blockade in comparison to 1μg/kg clonidine added to 29ml of 0.5% bupivacaine (p<0.05). It also prolongs the duration of sensory and motor blockade and postoperatively the duration of analgesia is prolonged with minimal reduction in pulse rate, blood pressure. Conclusion: The addition of dexmedetomidine to bupivacaine in brachial plexus block by supraclavicular approach results in a shorter onset time for sensory and motor blockade, prolongs the duration of sensory and motor blockade and also the duration of analgesia in comparison to clonidine.

Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

BackgroundBrachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB. MethodsIn this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to two equal study groups (n = 20), receiving 1 mL of 5 ..g.mL-1 sufentanil (group S) or 1 mL of 100 ..g.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40). ResultsThe duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0...130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0...130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0...7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0...-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting. ConclusionOur study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.

A comparative study between the effect of verapamil versus nalbuphine as an adjuvant in supraclavicular brachial plexus block

BackgroundBrachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline.ResultsResults of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block.ConclusionBoth drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

Evaluation of analgesic properties of verapamil as an adjuvant with 0.25% bupivacaine in USG guided supraclavicular brachial plexus block

Background: Peripheral nerve blocks are extensively preferred in perioperative pain management. Adding calcium blockers to local anesthetics agents can prolong the duration of analgesia. Verapamil, a calcium channel blocker is used extensively as an adjunct to lignocaine or bupivacaine for brachial plexus block due to its prolonged duration of action. This study was designed to evaluate whether additional anaesthetic and analgesic effect could be derived from administration of verapamil to 0.25% bupivacaine in supraclavicular brachial plexus block. Material and Methods: A total of 76 cases underdoing upper limb surgeries between age group 21 to 65 years belong to ASA grade I and II were recruited. Cases were randomly divided into 2 groups i.e. group 1 with USG guided brachial plexus block using 30ml of 0.25% bupivacaine with 2ml of normal saline and group 2 with 30 ml of 0.25% bupivacaine with 5mg of verapamil diluted to 2ml. Parameters like pulse rate, blood pressure, Spo2 were recorded before and after the block. Results: The mean difference of onset and duration of sensory and motor blockade between two study groups was statistically significant (P<0.005). The mean difference of duration of rescue analgesia was statistically significant between two study groups (P<0.003). The mean pulse rate, systolic blood pressure, diastolic blood pressure and oxygen saturation levels was comparable between two study groups and mean difference was statistically not significant (p>0.005). Conclusion: Verapamil as an adjunct to 0.25% bupivacaine in supraclavicular brachial plexus block acts efficiently in maintaining prolonged duration of analgesia.

Addition of Dexamethasone to Bupivacaine for Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

Addition of Dexamethasone to Bupivacaine for Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

Effect of Neostigmine on hemodynamic when added to Bupivacaine for Brachial Plexus Block

Effect of Neostigmine on hemodynamic when added to Bupivacaine for Brachial Plexus Block

Tramadol as an adjunct to bupivacaine for brachial plexus block.

Objectives: To compare the efficacy of tramadol and 0.25% bupivacaine versus 0.25% bupivacaine alone for brachial plexus block. Study Design: Randomized controlled study. Setting: Orthopedic department of Nishtar Medical University/Hospital Multan. Period: The study duration was Jan-2018 to Aug-2018. Material and Methods: 148 patients planned for with upper limb orthopedic procedures under BPB in the department of orthopedics department Nishtar Hospital Multan were included in this analysis. To Patients were randomly divided into two equal groups by lottery method. Group A patients were given solution with 38 ml 0.25% bupivacaine with 100 mg tramadol 2 ml and group B were given solution with 38 ml 0.25% bupivacaine and 2 ml 0.9 % normal saline. Time of onset of block and its duration and need for rescue analgesics were noted. Results: Time of onset of block was 14.56+1.01 minutes in group A versus 15.96+1.64 minutes in group B (p-value &lt;0.001). Mean analgesia duration was 355.85+42.18 minutes in group A versus 310.47+38.79 minutes in group B (p-value &lt;0.001). There were 51 (68.9%) patients in group A who required rescue analgesia and 68 (91.9%) patients in group B required rescue analgesia (p-value 0.004). Conclusion: We concluded that the addition of tramadol as adjunct to bupivacaine for BPB significantly shortens the duration of onset, prolongs the duration of analgesia and reduces the need for rescue analgesics.

Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Supraclavicular Brachial Plexus Block For Upper Limb Surgery

Background: Brachial plexus blocks are commonly used for forearm and hand surgeries but due to adverse effect like cardiotoxicity there is lot of research going on to find more cardiostable agent.Ropivacaine is commonly tried now adays in place of bupivacaine for brachial plexus block. It is new amino amide local anaesthetic having less cardiac toxicity as compared to bupivacaine. The present study was performed at our Institute to compare the Clinical characteristics of 0.5% ropivacaine and 0.5% bupivacaine when used for supraclavicular brachial plexus block in forearm and hand surgeries. Subjects and Methods: In this prospective randomised study sixty patients of ASA-I and II scheduled for forearm and hand surgeries under supraclavicular brachial plexus block were randomly divided into two groups of thirty each. Group R received Ropivacaine 0.5% 20 ml + 10ml normal saline while Group B received Bupivacaine 0.5% 20 ml + 10ml normal saline. Mean pulse, blood pressure,onset of sensory and motor blockade, duration of analgesia, and side effecs of local anaesthetic used were noted in both the groups. Statistical analysis for clinical characterstics was done by student t test and ANOVA was used to analyze hemodynamic variations between two groups. p 0.05). Conclusion: Supraclavicular brachial plexus block using either 0.5% Ropivacaine or 0.5% Bupivacaine have similar onset of sensory and motor blockade, duration of analgesia but due to potentially proven safety profile in the literatue compared to bupivacaine it may offer an advantage in modern clinical practice.

Erratum: Sensory and motor effects of dexmedetomidine as an adjuvant to bupivacaine for brachial plexus block

Erratum: Sensory and motor effects of dexmedetomidine as an adjuvant to bupivacaine for brachial plexus block

A Comparative Clinical Evaluation of Efficacy of Midazolam as an Adjuvant to Bupivacaine in Brachial Plexus Block by Supraclavicular Approach for Upper Limb Surgery

Introduction: Brachial plexus block is useful as a sole regional anesthetic technique for upper limb surgeries. Adjuvants to local anesthesia may enhance quality and duration of analgesia. Our study aimed to evaluate efficacy and safety of midazolam added to brachial plexus block. Methods: 394.50 ±46.874 243 ± 57.545 Addition of midazolam to bupivacaine for brachial plexus block prolongs the duration of analgesia with lower pain scores during post-operative period. A prospective, randomized, double blind study was conducted on 60 ASA I or II adult patients undergoing upper limb surgeries under single-shot supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 30) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 30) were given 30 mL of 0.5% bupivacaine with midazolam 2mg. Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores, onset of motor and sensory block, duration of analgesia and sedation score and were recorded intraoperatively and postoperatively.Results: The duration of analgesia was significantly prolonged (P&lt;0.05) in midazolam group (394.50 ±46.874 ) compared to control group (243 ±57.545). Similarly, pain scores were significantly lower in group BM than in group B (P&lt;0.05). The onset of motor and sensory block, sedation score and hemodynamic variables were comparable between groups. No adverse events were observed during study.Conclusion: Addition of midazolam to bupivacaine for brachial plexus block prolongs the duration of analgesia with lower pain scores during post-operative period. JNGMC, Vol. 14 No. 2 December 2016, Page: 26-29

Dexamethasone added to Bupivacaine prolongs the duration of analgesia for supraclavicular brachial plexus block

Background: Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia. Numerous adjuncts have been added to enhance the efficacy of the block. Steroids have anti-inflammatory as well as analgesic effects.Objectives: This study has been undertaken with a view to find out the efficacy of dexamethasone to increase the duration of analgesia when used as an adjuvant to bupivacaine in supraclavicular brachial plexus block in upper extremity surgery.Methods: Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block were randomly divided into two equal groups of 30 each; Bupivacaine group-‘’A’’ received 0.5% bupivacaine 2 mg/kg with distilled water 15 ml and Dexamethasone group-‘’B’’ received 0.5% bupivacaine 2 mg/kg with dexamethasone (0.2mg/kg) with distilled water 15 ml. The duration of analgesia in the two groups were compared.Results: There was markedly prolonged duration of analgesia in dexamethasone group. The mean duration of analgesia in bupivacaine group was 455 ± 17.09 minutes, whereas in dexamethasone group it was 864.50 ± 25.19 minutes. The results were statistically highly significant.Conclusion: Dexamethasone when added to bupivacaine in brachial plexus block it results significantly prolonged duration of post-operative analgesia, which was significantly higher in comparison to bupivacaine when it is used alone.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.296-301

A Comparative study on Adenosine and Magnesium Sulphate with Bupivacaine in Infraclavicular infusion for Postoperative Analgesia

Background: Brachial plexus piece has reformed the field of regional anaesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without significant difficulties. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Materials & Methods: This Prospective study was done at the Department of Anaesthesiology, Govt. Medical College, Azamgarh. Around 24 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/hand divided into two groups A (n-12) and B (n-12) 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: Our Study revealed that 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. Conclusion: The addition of magnesium sulphate as an additive to bupivacaine in brachial plexus block may be a better choice when prolonged postoperative analgesia is required.

Sensory and motor effects of dexmedetomidine as an adjuvant to bupivacaine for brachial plexus block

Background Dexmedetomidine is a highly selective (eight time more selective than clonidine), specific, and potent α2-adrenergic agonist having analgesic, sedative, antihypertensive, and anesthetic sparing effects when used in systemic routes. Patients and methods Forty patients of both sexes, aged between 25 and 70 years; American Society of Anesthesiologists I–II, who were submitted to elective upper limb surgery by supraclavicular brachial plexus block were included in the present study. They were selected during the period from March 2016 to June 2017. The patients were divided randomly by sealed envelopes into two equal groups (n=20). Group I: 20 patients received 30 ml bupivacaine 0.25%. Group II: 20 patients received 30 ml bupivacaine 0.25% plus 100 μg dexmedetomidine. Results The duration was reported in group II 13.13±1.10 and 16.50±1.63 min for the onset of sensory and motor blocks, respectively, and in group I 14.90±1.18 and 18.63±1.12 min for the onset of sensory and motor blocks, respectively. There was significant decrease of median pain score in group II when compared with group I at 4, 8, 12, 16, 20, and 24 h postoperatively. Conclusion Dexmedetomidine had significantly better postoperative analgesic effects, longer duration of sensory and motor blockade, and earlier onset of action. However, it had unwanted side effects in the form of transient bradycardia and hypotension.

Dexamethasone as an adjuvant to bupivacaine in brachial plexus block in upper limb surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Supraclavicular brachial plexus block is widely used for surgery below shoulder joint. Adding adjuvant to local anesthetic drugs enhance the duration of block as well as postoperative analgesia. Dexamethasone very potent glucocorticoid when added to local significantly prolongs the duration of analgesia&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This randomized, single blind, controlled study include 100 patients of either sex, aged 18–60 years, ASA status I–III, undergoing upper limb surgery were randomly allocated to receive either 0.375% 30 cc bupivacaine with 2 ml normal saline (group C, n=50) or 0.375% bupivacaine with 2 ml (8 mg) dexamethasone (group D, n=50). The observed parameters include onset and duration of motor and sensory block, duration of effective analgesia any side effects and hemodynamic (pulse rate, NIBP, SpO2). &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Mean onset time of sensory and motor block in group C was significantly longer as compared to group D. (p&amp;lt;0.0001) The duration of sensory and motor blockade was significantly prolonged in group D compared to group C. (p&amp;lt;0.0001) The duration of effective analgesia was also significantly prolonged in group D (931.2±69.88 mins) compared to group C (454.8±34.47 mins) (p&amp;lt;0.0001)&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Addition of dexamethasone to 0.375% bupivacaine in brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade. It also prolongs the duration of effective analgesia. &lt;/span&gt;&lt;/p&gt;

Adenosine and Magnesium Sulphate Vs Bupivacaine in Infraclavicular Infusion for Upper Limb Surgeries and Post-Operative Analgesia: A Prospective Study

Background: Brachial plexus piece has reformed the field of regional anesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without significant difficulties. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Methods: This Prospective study was done at the Department of Anaesthesiology, Pacific Medical College and Hospital, Udaipur, Rajasthan. Around 30 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/hand divided into two groups A (n-15) and B (n-15) 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: Result s showed that 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. Conclusions: The addition of magnesium sulphate as an additive to bupivacaine in brachial plexus block may be a better choice when prolonged postoperative analgesia is required.

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.