Levobupivacaine In Brachial Plexus Block Research Articles

Efficacy of Butorphanol and Tramadol as an Adjuvant to Levobupivacaine for Postoperative Analgesia in Brachial Plexus Block – A Randomized Double-Blind Study

Background: Supraclavicular brachial plexus block has evolved as a safe alternative to general anaesthesia with good postoperative analgesia. In an attempt to hasten the onset of block and increase the duration of postoperative analgesia, various adjuvant drugs are used along with local anesthetic agents. Aim: The present study was undertaken to assess the analgesic efficacy of butorphanol (2mg) and tramadol (100 mg) as an adjuvant to levobupivacaine in supraclavicular brachial plexus block during perioperative period. Study Design: This was a prospective, randomized, double blind study done on 100 adult patients of ASA I-III aged between 18-65 years and scheduled for various upper limb surgeries below the level of elbow. Materials and Methodology: Patients were allocated by computer generated random draw into two groups of 50 each and were administered the study drugs under ultrasonographic guidance. Both groups received 22ml of the study drug (Group B 20 ml 0.5% levobupivacaine + Butorphanol 2mg and Group T 0.5% levobupivacaine + Tramadol 100 mg). Patients were assessed for duration of postoperative analgesia, onset & duration of sensory as well as motor blockade and occurrence of any side effects. Results: Duration of postoperative analgesia was significantly elevated in group B (683±88.58 min), as compared to group T (483.2±45.24 min.) with p<0.001. Onset of sensory and motor blockade was comparable among both groups (p>0.05). Duration of sensory and motor block in group B was significantly longer compared to group T (p<0.001). Hemodynamics were stable and side effects were minimal in both the groups. Conclusion: Butorphanol 2mg when added to 20ml 0.5% levobupivacaine in brachial plexus block, significantly prolongs the duration of postoperative analgesia, sensory and motor block as compared to addition of 100 mg tramadol, with minimal side effects and hemodynamic changes. However, these adjuvants shorten the onset times of sensory and motor block to a similar extent. Keywords: Brachial plexus block, Levobupivacaine, Butorphanol, Tramadol, Analgesia.

A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block

Brachial plexus block is one of the best surgical technique for upper limb surgeries. It is a good anesthetic and analgesic agent. Though levobupivacaine has a duration of action of three to eight hours it has an acceptable analgesic property and few other practical constraints. Addition of vasoconstrictors like α-adrenergic agonists, hyaluronidase, neostigmine, opioids have been found to be effective. Dexmedetomidine, an α2 receptor agonist has found to be a better adjuvant to levobupivacaine by few literatures. To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 μg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score.This study was conducted after ethical committee clearance in a tertiary care medical college hospital in northern Kerala, India. 60 patients between the age of 18 and 60 years planned for upper limb surgery under brachial plexus block, who fulfilled the inclusion and exclusion criteria were included in the study. A pre anesthetic checkup was done to assess the patient before including in the study. The patients who were included in the study were randomly assigned into two groups – one group received 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine(LD group) and the second group received 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine(LS group) as anesthetic agent through sealed envelope technique. The clinical history, vitals and hemodynamic parameters were monitored and noted prior to and during the surgery. The data collected was analyzed and tabulated. There was no statistically significant difference between both groups with respect to age, Gender and weight signifying proper random allocation of study subjects. None in LD group required post operative analgesia. The mean duration of onset of sensory and motor block was earlier and duration of motor and sensory analgesia was prolonged with the addition of Dexmedetomidine to Levobupivacaine. The hemodynamic stability was better with Dexmedetomidine. Bradycardia was reported in 20% of study participants who were administered dexmedetomidine Dexmedetomidine added to levobupivacaine provides better anesthetic and analgesic care in upper limb surgeries done using brachial plexus block.

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

Introduction: Dexmedetomiodine is a selective α2 agonist drug. This study aimed to assess the onset and duration of sensory and motor block and postoperative analgesia in the first 12 hours after surgery after adding Dexmedetomidine with 0.375% Levobupivacaine for brachial plexus block. Material and Method: 100 patients aged 18-60 years of ASA Grade I & II posted for upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups with 50 patients in each. Group L and L+D received 35cc of 0.375% injection Levobupivacaine and 35cc of 0.375% Levobupivacaine with 1 µg/kg of injection Dexmedetomidine respectively through nerve stimulator guided supraclavicular block. Onset and duration of sensory and motor block, time to first and total analgesic need were noted postoperatively for 12 hours.Results: Sensory and motor block onset time was significantly lower in the Group L+D than Group L (p=0.001). Duration of sensory and motor block was significantly longer in the Group L+D than Group L (p=0.001). The time to the first analgesic requirement was longer in Group L+D than Group L (p=0.001). The total analgesic requirement was significantly lower in Group L+D than Group L (p=0.001).Heart rate and systolic and diastolic blood pressure was significantly lower after drug administration in group L+D than group L.Conclusion: Dexmedetomidine added to Levobupivacaine causes early onset and increased duration of sensory and motor block and prolonged period of postoperative analgesia in supraclavicular brachial plexus block. Therefore, Dexmedetomidine seems to be a good alternate adjuvant.

Effects of dexmedetomidine on the bispectral index and postoperative pain as an adjuvant to levobupivacaine for brachial plexus block

Objective To evaluate the effects of dexmedetomidine(Dex) on BIS of electroencephalograph in patients received supraclavicular brachial plexus blocking with levobupivacaine under ultrasound-assisted guidance. Methods Eighty patients undergoing distal arm and forearm surgeries and classified into ASA classⅠorⅡ were divided into two groups. One was control group (C group), in which patients received supraclavicular brachial plexus blocking with 30 ml levobupivacaine and 1 ml normal saline. The other was Dex group, in which patients(D group) received supraclavicular brachial plexus blocking with 30 ml levobupivacaine and 100 μg Dex in 1 ml normal saline. The supraclavicular brachial plexus blocking was performed under the guidance of ultrasound. BIS value, Ramsay sedation scores, and time to first rescuing analgesic after the surgeries(TAR) were recorded. Results In D group, the BIS values decreased significantly until 20 min after the brachial plexus blocking (P<0.05), but the Ramsay sedation scores was significantly increased(P<0.05), in comparison with C group. Time to administration of the first rescuing analgesic after the surgeries for pain relief was significantly delayed in D group than in C group(P<0.05). Conclusions Perineural dexmedetomidine administration for supraclavicular brachial plexus blocking with levobupivacaine had sedative effects that correspond to drops of BIS values, and significantly prolonged the duration of postoperative analgesia. Key words: Dexmedetomidine; Bispectral index; Ramsay sedation scores; Supraclavicular part of brachial plexus; Brachial plexus block

Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína

JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo braquial é técnica anestésica utilizada para procedimentos em membros superiores. O plexo braquial é território potencial para absorção de anestésicos locais. Estudos dos estereoisômeros da bupivacaína vêm demonstrando menor potencial de toxicidade da fração levógira (levobupivacaína) sobre o sistema cardiovascular. Porém, é discutida a eficácia anestésica (bloqueio sensitivo e motor) da levobupivacaína em anestesia do neuroeixo. Este estudo visa demonstrar a eficácia anestésica da levobupivacaína, comparandoa com a bupivacaína racêmica em bloqueio de plexo braquial, via perivascular subclávia. MÉTODO: Cinquenta pacientes adultos de ambos os sexos, ASA I e II, foram submetidos à anestesia de plexo braquial via perivascular subclávia para procedimentos ortopédicos de membros superiores, com auxílio de neuroestimulador. Foram divididos de modo aleatório em dois grupos: G BUPI - bupivacaína racêmica e G LEVO - levobupivacaína, num volume de 30 mL a 0,5%. O bloqueio sensitivo foi avaliado pelo método de "picada de agulha" nos metâmeros de C5 a C8; e o bloqueio motor, nos intervalos em minutos 1, 2, 5, 10, 15, 20, 25, 30 ou até instalação do bloqueio em movimentos dos dedos, mão, antebraço e braço. RESULTADOS: Não houve diferença estatística entre os dois grupos quanto à latência, incidência de falhas e grau do bloqueio motor, bem como incidência de falhas do bloqueio sensitivo, mas verificou-se diferença estatística da latência do bloqueio sensitivo em todos os metâmeros analisados. Não houve efeitos adversos inerentes à aplicação do anestésico local. CONCLUSÕES: A levobupivacaína demonstrou eficácia anestésica em bloqueio de plexo braquial, equiparável à solução racêmica usualmente empregada.

Supraclavicular Brachial Plexus Block: A Comparative Clinical Study between Bupivacaine and Levobupivacaine

Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local anesthetics. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine). However, the anesthetic efficacy (sensorial and motor blockades) of levobupivacaine in neuroaxis blocks has been debated. The objective of this study was to demonstrate the anesthetic efficacy of levobupivacaine in brachial plexus block, using the perivascular subclavian approach, by comparing it to racemic bupivacaine. Fifty adult patients of both genders, ASA I and II, underwent subclavian perivascular brachial plexus block, with the aid of a peripheral neurostimulator, for orthopedic surgeries of the upper limbs. Patients were randomly divided into two groups: G BUPI - racemic bupivacaine, and G LEVO - levobupivacaine, and they received 30 mL of the 0.5% solution. Sensorial blockade was evaluated by pinprick stimulation from C5 to C8 metameres; and the motor blockade was assessed 1, 2, 5, 10, 15, 20, 25, and 30 minutes after the administration of the local anesthetic or until blockade of fingers, hand, forearm, and arm movements was observed. Statistical differences in latency, failure rate, and degree of the motor blockade, and failure of the sensorial blockade between both groups were not observed, but the latency of the sensorial blockade in all metameres analyzed showed statistically significant differences. Adverse events inherent to the administration of local anesthetics were not observed. The anesthetic efficacy of levobupivacaine in brachial plexus block was similar to that of the racemic solution commonly used.