Ultrasound-guided Infraclavicular Brachial Plexus Block Research Articles

0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial

IntroductionIn an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of...

A Randomized Controlled Trial Comparing the Analgesic Efficacy of Programmed Intermittent Bolus vs. Continuous Infusion of Ropivacaine and Fentanyl in Ultrasound-Guided Infraclavicular Brachial Plexus Block for Upper Limb Surgery.

Programmed intermittent bolus (PIB) is a novel method of intermittent drug delivery commonly employed in labor epidural analgesia. This study aimed to evaluate the potential benefits of PIB over continuous infusion (CI) for postoperative analgesia following upper limb surgeries distal to the mid-humerus level using ultrasound-guided infraclavicular brachial plexus block (USG-IBPB). The USG-IBPB was performed on a total of 30 patients scheduled for upper limb surgery distal to the mid-humerus level. The patient-controlled regional analgesia pump delivered a combination of 6 mL of 0.2% ropivacaine and 2 μg/mL fentanyl via a perineural catheter as PIB in group I and as a CI in group II. The primary outcome measure was overall drug consumption, and secondary outcomes included pain scores, patient satisfaction, sensory and motor blockade, and adverse effects. The PIB group exhibited significantly lower overall drug consumption (306.20 ± 13.07 mL vs. 323.73 ± 11.79 mL; P = 0.001), a reduced need for patient-controlled analgesia boluses (3.87 ± 2.67 vs. 7.13 ± 2.36; P = 0.001), and higher patient satisfaction (91.93 ± 10.09 vs. 78.67 ± 17.57; P = 0.017) compared to the CI group. Pain scores at rest were significantly lower at the 24-hour mark (P = 0.007), and on movement, lower scores were observed after 1, 24, and 36 hours (P = 0.031, P = 0.031, and P = 0.011, respectively). Sensory block, motor block, and adverse effects were similar between the two groups. PIB demonstrated superior efficacy in postoperative analgesia compared to the CI technique for upper limb surgeries distal to the mid-humerus level. Therefore, PIB may be considered an effective alternative to CI for optimal postoperative pain management.

Blockade of intercostobrachial nerve by an erector spinae plane block at T2 level: a case report

BackgroundThe intercostobrachial nerve blockade is required, in addition to brachial plexus block, to anesthetize the entire upper arm. No studies have described the use of erector spinae plane (ESP) block for an intercostobrachial nerve block.Case presentationA 72-year-old man was scheduled to undergo left brachial vein transposition-arteriovenous fistula creation for hemodialysis access. An ultrasound-guided infraclavicular brachial plexus block was performed using a mixture of 0.5% levobupivacaine (12.5 ml) and 2% lidocaine (12.5 ml). An ESP block was implemented using 10 ml of the same local anesthetic at the T2 level. A pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall were anesthetized 20 min after the blocks. Surgery was successfully performed without the need for general anesthesia.ConclusionsIn the present case, an ESP block performed at the T2 level provided sensory loss of the area innervated by the intercostobrachial nerve.

The Comparison of Dexmedetomidine to Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block in Upper Limb Surgeries.

Background The clinical utility of adjuvants with local anesthesia produces an excellent nerve block with prolonged duration and faster onset.Brachial plexus block is widely used nowadays in patientsundergoing upper limb surgery There are several approaches to achieve brachial plexus block such as interscalene, supraclavicular, infraclavicular, and axillary. The objective of this study is to compare the effectiveness of dexamethasone to dexmedetomidine as adjuvants to bupivacaine in patients undergoing ultrasound-guided infraclavicular brachial plexus (USG-ICBP) block. Methods A randomized, prospective, double-blind study was undertaken on the patients posted for upper limb surgeries under ultrasound-guided infraclavicular brachial plexus block. Sixtypatients with the American Society of Anesthesiologists (ASA) classes I and II were randomly allocated into two groups. Group A received 25 mL of 0.5% bupivacaine and 1.5 mL (6 mg) of dexamethasone, and group B received 25 mL of 0.5% bupivacaine and 0.75 mL (75 mcg) of dexmedetomidine along with 0.75 mL of 0.9% normal saline (NS). Student's t test or Mann-Whitney test and chi-square test were used for statistical analysis. Results The onset of sensory block was significantly faster in the patients in group B as compared to the patients in group A. In terms of the duration of the block, sensory and motor blocks were maintained for a significantly longer duration in the group A patients as compared to those in group B. Moreover, the duration of postoperative analgesia was significantly longer-lasting in the group A patients. In terms of adverse effects, procedure-related complications such as the failure of the block and inadequate block were comparable across the groups. However, drug-related adverse effects were significantly more common in group B. Conclusion As compared to 75 mcg of dexmedetomidine, the addition of 6 mg of dexamethasone as adjuvant to 25 mL of 0.5% bupivacaine resulted in significantly longer-lasting sensory and motor blocks, postoperative analgesia, and a delayed time for first rescue analgesia without increasing undue adverse effects. Dexmedetomidine use is associated with more sedation as compared to dexamethasone.

Comparison of ropivacaine 0.5% with dexmedetomidine and clonidine as adjuvants in ultrasound-guided infraclavicular brachial plexus block for upper limb surgery

Background: The Institutional Ethics Committee and patients' informed written consent were obtained before this study was carried out in the Department of Anaesthesiology at Sardar Patel Medical College in Bikaner, Rajasthan. An established method for delivering anaesthesia and analgesia during upper limb surgery is brachial plexus block. For peripheral nerve blocks, ropivacaine, a long-acting amide with a safe cardiac profile, is chosen. It has been proven that different adjuncts may be added to LA solutions to boost their effectiveness and longevity while lowering the overall dose of LA utilised and minimising any systemic side effects. Our goal was to assess the effectiveness of adjuvants such as dexmedetomidine and clonidine in comparison to 0.5% ropivacaine in an infraclavicular block for upper limb surgery under USG guidance. Method: Fifty adult patients planned for elective upperlimb surgery with an infraclavicular brachial plexus block under USG guidance were included. All research participants were split into two groups at random. In groups D and C, respectively, dexmedetomidine and clonidine were used as adjuvants with 0.5% ropivacaine. Our main goal was to compare the postoperative analgesic duration in both research groups, as well as the onset and duration of sensory and motor block. Patients were monitored for any complications connected to the medicine and procedure while hemodynamic indicators were also compared. Results: Group D's sensory and motor block action initiation time was substantially quicker than that of group C's (p 0.001). When compared to Group C, Group D's sensory and motor block and postoperative analgesia durations were considerably longer (p value 0.001). Conclusion: Dexmedetomidine is a more effective adjuvant than clonidine when given during upper limb surgery with an infraclavicular block that is guided by a USG.

Comparison of ropivacaine 0.5% with dexmedetomidine and clonidine as adjuvants in ultrasound-guided infraclavicular brachial plexus block for upper limb surgery

Background: The Institutional Ethics Committee and patients' informed written consent were obtained before this study was carried out in the Department of Anaesthesiology at Sardar Patel Medical College in Bikaner, Rajasthan. An established method for delivering anaesthesia and analgesia during upper limb surgery is brachial plexus block. For peripheral nerve blocks, ropivacaine, a long-acting amide with a safe cardiac profile, is chosen. It has been proven that different adjuncts may be added to LA solutions to boost their effectiveness and longevity while lowering the overall dose of LA utilised and minimising any systemic side effects. Our goal was to assess the effectiveness of adjuvants such as dexmedetomidine and clonidine in comparison to 0.5% ropivacaine in an infraclavicular block for upper limb surgery under USG guidance. Method: Fifty adult patients planned for elective upperlimb surgery with an infraclavicular brachial plexus block under USG guidance were included. All research participants were split into two groups at random. In groups D and C, respectively, dexmedetomidine and clonidine were used as adjuvants with 0.5% ropivacaine. Our main goal was to compare the postoperative analgesic duration in both research groups, as well as the onset and duration of sensory and motor block. Patients were monitored for any complications connected to the medicine and procedure while hemodynamic indicators were also compared. Results: Group D's sensory and motor block action initiation time was substantially quicker than that of group C's (p 0.001). When compared to Group C, Group D's sensory and motor block and postoperative analgesia durations were considerably longer (p value 0.001). Conclusion: Dexmedetomidine is a more effective adjuvant than clonidine when given during upper limb surgery with an infraclavicular block that is guided by a USG.

A Randomized Controlled Trial to Compare the Efficacy of Single versus Triple Injection Technique for Ultrasound-Guided Infraclavicular Block in Upper Limb Surgeries.

The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region.Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient's satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods. This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups - Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone. The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups. We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.

Comparison of the efficacy of two doses of dexmedetomidine as an adjunct to levobupivacaine in infraclavicular brachial plexus block: prospective double-blinded randomized controlled trial

BackgroundThis prospective, double-blind, randomized, controlled trial compared the efficacy of two dexmedetomidine doses (50 and 100-μg) combined with levobupivacaine on sensory block duration in infraclavicular brachial plexus block. We hypothesized that perineural dexmedetomidine would extend sensory block duration dose-dependently.MethodsThe study included 60 patients aged 20 to 60 years of both sex with an ASA I/II undergoing forearm and hand surgery. The patients were randomly assigned into three equal groups (n = 20) for ultrasound-guided infraclavicular brachial plexus block. The L group received 35-mL 0.5% levobupivacaine plus normal saline, the LD50 group received 35-mL 0.5% levobupivacaine plus 50-μg dexmedetomidine, and the LD100 group received 35-mL 0.5% levobupivacaine plus 100-μg dexmedetomidine. Patients were investigated for onset and duration of sensory blockade, time to first postoperative rescue analgesia, and the total 24-h postoperative morphine requirement.ResultsThe LD100 group had a longer sensory block duration (15.55 ± 1.1 h; 95% confidence interval (CI), 15.04–16.06) than the LD50 group (12.8 ± 1.2 h; 95% CI, 12.24–13.36 h) (p < 0.001) or the L group (9.95 ± 1.05 h; 95% CI, 9.46–10.44 h) (p < 0.001). The LD100 group took longer to request postoperative rescue analgesia and required fewer postoperative morphine doses than the LD50 and L groups (P < 0.001).ConclusionsSensory block duration was longer with perineural 100-μg dexmedetomidine as an adjunct to levobupivacaine than with 50-μg dexmedetomidine.Trial registrationThis study was approved by the Ethics Committee of Aswan University Hospital (approval number: aswu/125/4/17) (date of registration: 04/04/2017). Furthermore, the trial was retrospectively registered at ClinicalTrial.gov (NCT04729868) with a verification date of January 2021.

Comparison of Ultrasound-Guided Infraclavicular Brachial Plexus Block Sensorial Duration in Diabetic and Non-diabetic Patients: A Prospective Observational Study.

Objective:Diabetic neuropathy is one of the most common complications of diabetes mellitus. Recovery from peripheral nerve blocks in diabetic patients with neuropathy may be delayed because of axonal degeneration and segmental demyelination. The aim of this study is to compare the infraclavicular brachial plexus block durations in patients with and without diabetes mellitus type 2.Methods:This prospective observational study included 60 patients who were aged 40-80 years, with American Society of Anesthesiologists I-IV physical status and scheduled for elbow, forearm, and/or hand surgery under infraclavicular brachial plexus blocks. All 30 patients in Group DM (patients with diabetes mellitus type 2 diagnosis) and 29/30 patients in Group NODM (patients without diabetes mellitus diagnosis) completed the study successfully. The sensorial block duration was documented as the primary outcome, and the motor block duration, time-to-first pain, numeric rating scale scores at rest/during mobilization, rescue analgesic use, and total consumed doses through the first 2 postoperative days were all documented as the secondary outcomes.Results:Sensorial block duration in Group DM (505 [315-1020] minutes) was longer than in Group NODM (440 [160-780] minutes) (P = .016). Motor block duration was also longer (488.7 ± 153.8 minutes vs 379.2 ± 118.9 minutes; P = .003), and time-to-first pain was prolonged (625 [360-1200] minutes vs 520 [300-900] minutes; P = .004) in Group DM. The highest NRS scores at the 6th hours, 12th hours, and rescue analgesic consumption through the first 2 postoperative days were lower in Group DM (P < .05).Conclusion:This infraclavicular brachial plexus block study highlights the current literature on diabetic patients with respect to longer block durations, prolonged time-to-first pain, lower pain scores, and less analgesic consumption.

Evaluation of Block Success in Patients Undergoing Ultrasound-Guided Infraclavicular Brachial Plexus Block with Bilateral Upper Extremity Perfusion Index

Evaluation of Block Success in Patients Undergoing Ultrasound-Guided Infraclavicular Brachial Plexus Block with Bilateral Upper Extremity Perfusion Index

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

BackgroundWe aimed to determine the minimum effective volume (MEV) of 0.5% bupivacaine for infraclavicular brachial plexus block. MethodsWe assigned patients to volume groups consisting of five consecutive patients. Local anesthetic was sequentially reduced from a starting dose of 30 mL by 2 mL to form the volume groups. Five patients were included in each volume group, and at least 3 of 5 injections had to be successful to consider the volume of the anesthetic as sufficient. The study ended when the anesthetic volume of a group was determined to be unsuccessful (two or fewer successful blocks). Block was successful if the patient reported a sensorial block score of 7 or more on an 8-point scale and sensorial and motor block's total score of 14 on a 16-point scale. ResultsThe MEV of 0.5% bupivacaine for infraclavicular brachial plexus block was 14 mL. A successful block was achieved in all patients (n = 45) in 9 volume groups, which received 30 mL down to 14 mL. Three blocks were unsuccessful in the 12-mL group. Time to onset of block and time to first postoperative anesthetic administration was 15 (10–15) min and more than 24 h in the 30-mL bupivacaine group, but 40 (30–45) min and 14 (10–24) h were determined for the 14-mL group, respectively. ConclusionsThe MEV of 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block was 14 mL. However, this low-dose block has a long onset time of 40 (30–45) min on average.

Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial.

IntroductionIn this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels.MethodsA total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US‑guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes.ResultsThe block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups.ConclusionBased on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.

Comparison of the onset time between 0.375% ropivacaine and 0.25% levobupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized-controlled trial

At centers with pressure on rapid operating room turnover, onset time is one of the important considerations for choosing a local anesthetic drug. To hasten the onset of the block, higher concentrations of local anesthetics are sometimes used. However, the use of diluted local anesthetics may be safer. Therefore, we aimed to compare the onset times of equipotential levobupivacaine and ropivacaine at low concentrations for infraclavicular brachial plexus block. Adult patients undergoing upper extremity surgery under ultrasound-guided infraclavicular brachial plexus block at our center were randomly allocated to the levobupivacaine and ropivacaine groups. Infraclavicular brachial plexus block was induced with 0.25% levobupivacaine or 0.375% ropivacaine depending on the assigned group. The degrees of sensory and motor blockade were assessed for 40 min after the administration of local anesthetics. A total of 46 patients were included in the analysis. Infraclavicular brachial plexus block with 0.25% levobupivacaine and 0.375% ropivacaine provided sufficient surgical anesthesia. The sensory onset time of 0.375% ropivacaine was shorter than that of 0.25% levobupivacaine (group R, 15 [15.0–22.5] min; group L, 30 [17.5–35.0] min, p = 0.001). There were no significant differences in other block characteristics and clinical outcomes between the two groups. Thus, when a quicker block onset is required, 0.375% ropivacaine is a better choice than 0.25% levobupivacaine.Trial registration ClinicalTrials.gov (NCT03679897).

Comparison of Perineural and Intravenous Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block: A prospective Randomized Trial.

Background:The effect of perineural versus intravenous (i.v.) dexamethasone (4 mg) when added to levobupivacaine as an adjuvant has not been well studied.Aims:This study was conducted to compare the analgesic efficacy of perineural and i.v. dexamethasone as an adjuvant to levobupivacaine in infraclavicular brachial plexus (ICBP) block.Settings and Design:This was a prospective, randomized, double-blind study.Materials and Methods:This study was conducted on 68 patients with the ultrasound-guided ICBP block, randomly allocated into two groups (34 each). Four patients had failed block (2 in each group) that was excluded from the study. Group A received 25 mL of levobupivacaine 0.5% and 1 mL of normal saline for the block and i.v. dexamethasone 4 mg. Group B received 25 mL of levobupivacaine 0.5% with 4 mg of perineural dexamethasone for the block. Postoperative vitals and different block characteristics were assessed.Statistical Analysis Used:Student's independent sample t-test and Chi-square test were used for statistical analysis.Results:The duration of motor block and analgesia in Group A was 1245.94 ± 153.22 min and 1310.16 ± 151.68 min, respectively. However, in Group B, the duration of motor block and analgesia was 1768.13 ± 309.86 min and 1743.59 ± 231.39 min, respectively, which was more when compared to Group A (P < 0.001). The Visual Analog Scale score of ≥3 in Group A was 37% and in Group B was 9% (P = 0.008). Four cases had delayed regression of motor block in the perineural group.Conclusions:Perineural dexamethasone significantly prolonged the duration of motor block promoted by levobupivacaine in infraclavicular brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period when compared with the intravenous dexamethasone.

Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

BackgroundOnvision is a new technology for needle tip detection and tracking in ultrasound-guided regional anesthesia. The system consists of a piezoelectric sensor close to the needle tip and an electronic...

A review of the anatomy and a step-by-step visual guide to performing an ultrasound-guided infraclavicular brachial plexus block

Background: The aim of this description is to provide step-by-step guidelines for performing an ultrasound guided infraclavicular brachial plexus nerve block. Methods: The brachial plexus in the infraclavicular fossa of sixty healthy volunteers was scanned in the horizontal/transverse plane. The relevant regional anatomy was studied to identify the muscular and vascular structures seen on the ultrasound screen. Results: The entire process was documented and a standard, step-by-step guide to performing ultrasound guided vertical infraclavicular brachial plexus blocks was developed. Conclusion: The development of high-resolution ultrasound guidance has allowed for the direct visualisation of the brachial plexus when performing nerve blocks. Ultrasound-guided infraclavicular brachial plexus nerve blocks are becoming more popular. This description aimed to provide step-by-step guidelines on how to perform this block safely and efficiently.

A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block.

Background and Aims:The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area – lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection.Methods:USG ICBPB was performed in 10 cadavers—5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ, and US characteristics were noted. Anatomical dissection was done and important structures were described in detail.Results:Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the 'blind spot' behind the clavicle is an area where neurovascular structures were present.Conclusion:The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a 'blind-spot' for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.

Efficacy of multimodal analgesia with perineural buprenorphine or dexmedetomidine for surgeries performed under ultrasound-guided infraclavicular brachial plexus block.

Background and Aims:Perineural adjuvants when used as a part of multimodal analgesia (MMA) will maximize the quality and duration of analgesia of the nerve blocks. In the present study, we compared the duration of postoperative analgesia and other block characteristics of two groups of MMA comprising either perineural buprenorphine or dexmedetomidine in the upper limb surgeries performed under ultrasound-guided (US-guided) infraclavicular brachial plexus blocks.Material and Methods:A total of 100 adult patients undergoing elective upper limb orthopedic surgery under US-guided infraclavicular brachial plexus block were randomly divided into two groups. Group I received 150 μg buprenorphine and Group II received 50 μg dexmedetomidine, perineurally added to 30 ml of 0.375% bupivacaine. Both groups also received tramadol 50 mg IV, dexamethasone 4 mg IV, and diclofenac 75 mg infusion as part of MMA. Both groups were compared for the duration of postoperative analgesia, block characteristics, and incidence of adverse effects.Results:The duration of postoperative analgesia was significantly prolonged in Group II (937.6 ± 179.1 min vs 1280.4 ± 288.8 min). The onset of sensory and motor blocks was shorter in Group II (P < 0.05). The duration of sensory and motor blocks was significantly prolonged in Group II (P < 0.05). The number of rescue analgesics required in the first 24 hours was less in Group II (1.98 ± 0.62 vs 0.8 ± 0.64). Although heart rate and blood pressure levels were lower in Group II, all patients were hemodynamically stable.Conclusion:For surgeries under brachial plexus block, perineural dexmedetomidine when used as a part of MMA provided a prolonged duration of postoperative analgesia and improved block characteristics than perineural buprenorphine.

Comparing Postoperative Analgesic Effect of Dexmedetomidine or Dexamethasone Added to Lidocaine Through Infraclavicular Block in Forearm Surgery.

The objective of this study was to compare the analgesic efficacy of dexamethasone versus dexmedetomidine added to lidocaine using infraclavicular block in patients undergoing forearm fracture surgery. Seventy-five patients aged 20 to 60 years were recruited for a prospective, double-blinded, randomized clinical trial. Ultrasound-guided infraclavicular brachial plexus block was performed in 3 groups by injecting 28 mL lidocaine plus 2 mL distilled water (Lido), 28 mL lidocaine plus 2 mL (8 mg) dexamethasone (Dexa), and 28 mL lidocaine plus 2 mL (1 µg/kg) dexmedetomidine (Dexm). Sensory and motor block onset time and the duration, hemodynamic variables, the time for the first analgesic request, and the total analgesic agents consumed within 6 hours after infraclavicular block were assessed. Sensory block duration in the Dexm group was significantly greater than in the Lido (P=0.019) and Dexa (P=0.046) groups. The mean motor block duration in the Dexm group showed to be significantly longer than that in the Lido group (P=0.009). Pain intensity within 4 hours after block significantly increased in the Lido group compared with that in the Dexa and Dexm groups (P=0.001). Analgesic consumption during 6 hours after the procedure was higher in the Lido group when compared with the other 2 groups (P=0.001). The Dexm group showed the highest reduction in the mean arterial pressure (P=0.006) and heart rate (P=0.001) among the 3 groups. There was no significant difference in postoperative pain intensity between the Dexa and Dexm groups, although DEXm demonstrated a longer sensory block duration in comparison with dexamethasone as a lidocaine adjuvant in infraclavicular block.

Microcirculation and haemodynamics after infraclavicular brachial plexus block using adrenaline as an adjuvant to lidocaine: a randomised, double-blind, crossover study inhealthy volunteers.

We evaluated the effect of adrenaline on human skin microcirculation (nutritive and sub-papillary) and systemic cardiovascular variables after it was added to lidocaine in infraclavicular brachial plexus blocks. Twelve healthy, non-smoking male volunteers were included, each attending two study sessions 2weeks apart, and they were studied using a crossover design. In both sessions, they received an ultrasound-guided infraclavicular brachial plexus block in the non-dominant arm with 0.4ml.kg-1 lidocaine, 15mg.ml-1 with or without adrenaline 5μg.ml-1 . Microcirculation was assessed by laser Doppler fluxmetry (sub-papillary blood flow), capillary video microscopy (nutritive blood flow) and continuous temperature measurements. Heart rate and arterial pressure were recorded continuously and non-invasively. Median (IQR [range]) sub-papillary blood flow increased substantially 30min after the brachial plexus block, from 8.5 (4.4-13.5 [2.9-28.2]) to 162.7 (111.0-197.8 [9.5-206.7]) arbitrary units with adrenaline (p=0.017), and from 6.9 (5.3-28.5 [1.8-42.1] to 133.7 (16.5-216.7 [1.0-445.0] arbitrary units without adrenaline (p=0.036). Nutritive blood flow (functional capillary density, capillaries.mm-2 , measured at the dorsal side of the hand) decreased in the blocked extremity when adrenaline was used as adjuvant, from median (IQR [range]) 45 (36-52 [26-59]) to 38 (29-41 [26-42]), p=0.028, whereas no significant change occurred without adrenaline. Median finger skin temperature (°C) increased by 44% (data pooled) with no significant differences between the groups. No significant changes were found in the systemic cardiovascular variables with or without adrenaline. We conclude that lidocaine infraclavicular brachial plexus blocks caused an increase in skin sub-papillary blood flow. The addition of adrenaline produced stronger and longer lasting blocks, but decreased the nutritive blood flow.