Ultrasound-guided Supraclavicular Brachial Plexus Block Research Articles

A randomised trial comparing block characteristics of a mixture versus sequential injections of lignocaine and ropivacaine for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

A comparative study between 0.5% ropivacaine with 50 mcg of dexmedetomidine and 0.5% ropivacaine with 8 mg of dexamethasone for ultrasound-guided supraclavicular brachial plexus block – A randomized controlled study

Background: Peripheral nerve block analgesia is augmented using dexamethasone with perineural local anesthesia. Aims and Objectives: The study aimed to assess and compare the effects of dexmedetomidine and dexamethasone on the onset and duration of the sensory and motor block when added to 0.5% ropivacaine for the supraclavicular brachial plexus block. Materials and Methods: This randomized controlled study was conducted at the Department of Orthopedics, Government Stanley Medical College and Hospital, Chennai, for 6 months March 2021–September 2021). Eighty patients were randomly allocated into two groups. Group A (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexmedetomidine 50 mcg (0.5 mL)+normal saline (1.5 mL). Group B (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexamethasone 8 mg (2 mL). Results: The dexmedetomidine group had a significantly faster onset of sensory anesthesia (3.9 min) than the dexamethasone group (7.8 min), with a higher duration. The dexmedetomidine group also had a faster onset of motor anesthesia (4.9 min) and a longer duration of analgesia (892.3 min) compared to the dexamethasone group (538 min). The dexmedetomidine group also had a longer duration for rescue analgesia (906 min) than the dexamethasone group (727 min). Visual Analog scores at 10, 14 and 24th h were lower in the dexmedetomidine group than in the dexamethasone group, which is statistically significant (P<0.001). Conclusion: Dexmedetomidine has a faster onset, longer duration, longer analgesia, and prolonged duration for rescue analgesia compared to dexamethasone for ultrasound-guided supraclavicular brachial plexus block, with bradycardia and sedation as side effects.

Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

ULTRASONOGRAPHIC EVALUATION OF DIAPHRAGMATIC PARALYSIS FOLLOWING SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK BY DIFFERENT VOLUMES OF 0.5% BUPIVACAINE

Background: Ultrasound guidedsupraclavicular brachial plexus block is widely used technique in anaesthesiafor upper limb surgeries. However it can block phrenic nerve to cause diaphragmatic palsy. It is difficult to avoid even with ultrasound-guided supraclavicular brachial plexus block. Objectives: Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular brachial plexus block using different volumes of 0.5% bupivacaine. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I and II were randomized to receive 20ml (group A) and 30 ml (group B) of 0.5% bupivacaine in a double blinded fashion. Ultrasound guided supraclavicular brachial plexus block was performed. Diaphragmatic excursion was studied using a curvilinear 3.5 MHz transducer before and 20 min after giving the block. Results: The incidence of partial diaphragmatic paralysis in the group A and group B were 33% and 40% respectively. None of the patient in group A had complete paralysis whereas only 2(6.6%) patients had complete paralysis in group B. Conclusion: Risk of phrenic nerve block was involved even in ultrasound guided supraclavicular brachial plexus block. Hemidiaphragmatic paralysis is volume dependent, and the overall incidence is higher at greater volumes. Hence, caution is required in patients with pre-existing cardiorespiratory dysfunction.

The 90% minimum effective volume of 0.5ropivacaine for ultrasound-guided supraclavicular brachial plexus block : Abiased coin up-and-down design.

Ultrasound-guided supraclavicular brachial plexus block is widely used in upper limb surgery; however, it requires ahigher dose (20-30 mL) of local anesthetic. In this study, we aimed to determine the 90% minimum effective volume for ultrasound-guided supraclavicular brachial plexus block. All patients received an ultrasound-guided two-point injection of 0.5% ropivacaine at astarting volume of 0.18 mL/mm2 cross-sectional nerve area. In cases of asuccessful block, the next patient had the same volume with aprobability of 0.89, and the volume was reduced by 0.04 mL/mm2 cross-sectional nerve area with aprobability of 0.11. When the block failed, the dose was increased by 0.04 mL/mm2 cross-sectional nerve area. After 45cases of successful blocks, the 90% minimum effective volume of local anesthetic was calculated using the centered isotonic regression function. Centered isotonic regression analysis resulted in a90% minimum effective volume and a95% confidence interval of 0.189 mL/mm2 and 0.176-0.225 mL/mm2 for the supraclavicular brachial plexus block. Agood blocking effect can be achieved with 0.189 mL/mm2 of 0.5% ropivacaine with more precise dosing, thereby reducing the risk of local anesthetic poisoning.

Dexmedetomidine versus Midazolam as Local Anesthetic Adjuvants to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper-Limb Vascular Surgeries: A Comparative Study

Dexmedetomidine versus Midazolam as Local Anesthetic Adjuvants to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper-Limb Vascular Surgeries: A Comparative Study

Comparative study between ketamine-bupivacaine versus bupivacaine with intravenous ketamine infusion in supraclavicular brachial plexus block during upper limb surgeries

Background Theb only drawback of using local anesthetics alone for supraclavicular brachial plexus block is that postoperative analgesia lasts for a shorter period. To block brachial plexus quickly and completely, different adjuvants, including opioids, dexmedetomidine, dexamethasone, midazolam, and ketamine, had been used with local anesthetics. Aim of the study was to compare the efficacy of adding ketamine to bupivacaine versus intravenous ketamine infusion with supraclavicular brachial plexus. Methods Sixty studied cases planned to undergo unilateral elective upper limb surgeries using ultrasound-guided supraclavicular brachial plexus block were separated into two groups: group 1: 20 ml bupivacaine 0.5% plus ketamine (1 mg/kg) with a maximum dose of 100 mg; (the total volume is 30 ml), with the infusion of 100 ml normal saline at a rate of 100 ml/h and group 2: 20 ml bupivacaine (0.5%) plus 10 ml saline; (the total volume is 30 ml) with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline at a rate of 100 ml/h, that was stopped 5 min before the end of surgery. Results Visual Analog Scale (VAS), heart rate and mean arterial pressure were significantly lower at 12 h postoperatively in group 1. The onset of sensory, motor block, duration of sensory and motor block were significantly lower in group 1 compared with group 2. The time of first rescue analgesia was significantly delayed in group 1 compared with group 2. Total ketorolac requirements were significantly lower in group 1. Conclusions Using ketamine bupivacaine in supraclavicular brachial plexus block in upper limb surgeries is effective in improving the onset of brachial plexus block and prolonging the time of brachial plexus block with no hemodynamic changes.

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

IntroductionRecent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete...

Median effective volume of 0.2% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in children aged 1-6 years: a prospective dose-finding study.

To determine the median effective volume (EV50) of 0.2% ropivacaine for ultrasound-guided supraclavicular brachial plexus block (SC-BPB) in children aged 1-6 years. Children aged from 1 to 6 years with an American Society of Anaesthesiologists (ASA) physical status I-II who were scheduled for unilateral upper extremity surgery at the Children's Hospital of Chongqing Medical University were recruited. All patients underwent surgery under general anaesthesia combined with brachial plexus block. SC-BPB was guided by ultrasound after anaesthesia induction, and 0.2% ropivacaine was given after localization. In the study, we used Dixon's up-and-down approach with an initial dose of 0.50 ml/kg. Considering the effect of the previous block, a successful or failed block could produce a 0.05 ml/kg decrement or increment in volume, correspondingly. The experiment was stopped when there were 7 inflection points. Using isotonic regression and bootstrapping algorithms, the EV50, the 95% effective volume (EV95) and the 95% confidence interval (CI) were calculated. The patients' general information, postoperative pain scores, and adverse events were also recorded. Twenty-seven patients were involved in this study. The EV50 of 0.2% ropivacaine was 0.150 ml/kg (95% CI, 0.131-0.169 ml/kg) and the EV95 (secondary metric) was 0.195 ml/kg (95% CI, 0.188-0.197 ml/kg). No adverse events occurred during the research study. For ultrasound-guided SC-BPB in children aged 1-6 years undergoing unilateral upper extremity surgery, the EV50 of 0.2% ropivacaine was 0.150 ml/kg (95% CI, 0.131-0.169 ml/kg).

A Comparative Study on the Efficacy between 0.75% Ropivacaine with Dexmedetomidine and Dexamethasone as Adjuvants for Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

A Comparative Study on the Efficacy between 0.75% Ropivacaine with Dexmedetomidine and Dexamethasone as Adjuvants for Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Effect of adding neostigmine to bupivacaine for ultrasound-guided supraclavicular brachial plexus block in forearm surgeries a randomized, blinded, controlled study

Background: In our study, we investigated the effect of adding neostigmine to local anesthetic on the supraclavicular brachial plexus block. Patients and Methods: This prospective, randomized, blinded controlled experiment included 80 patients of either sex with an ASA I or II physical status who were planned for forearm operations under ultrasound-assisted supraclavicular brachial plexus block. Participants were separated randomly into two groups and given a supraclavicular block with 25 mL of 0.5% bupivacaine and 1 mL of 0.9 % saline for the control group and 25 mL of 0.5% bupivacaine and 1 mL of neostigmine (0.5mg) for the neostigmine group. Results: In the neostigmine group, sensory and motor blockade began earlier and lasted longer than in the control group. The neostigmine group took substantially longer to seek their first analgesia. The neostigmine group used fewer analgesics in total. At 1, 2, 4, and 6 hours, the neostigmine group had statistically reduced VAS scores than the control group. Conclusion: Patients undergoing forearm procedures benefit from the usage of neostigmine in addition to bupivacaine in ultrasound-assisted supraclavicular brachial plexus block because it reduces the onset of sensory and motor block and lengthens its duration. These results were clear with a dosage of (0.5 mg).

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine in Ultrasoundguided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Introduction: Upper limb surgeries are mostly performed under supraclavicular brachial plexus blocks which provide intraoperative and postoperative analgesia. Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement, and adequate local anaesthetic spread. Adding adjuvants to local anaesthetic drugs prolong the duration of anaesthesia without concomitantly increasing the risk of complication. Aim: To compare fentanyl and dexmedetomidine when added as an adjuvant to ropivacaine for Ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A prospective observational, doubleblinded study was conducted in the Department of Anaesthesia, at Government Medical College, Kottayam, Kerala, India, on 52 patients undergoing orthopaedic upper limb surgeries over a period of one year from April 2019-March 2020. Patients were divided into two groups of 26 subjects each. Group A received ropivacaine 0.5% (20 mL)+dexmedetomidine 1 mcg/kg and group B received ropivacaine 0.5% (20 mL)+Fentanyl 1 mcg/kg. Onset, time to complete sensory and motor block, duration of sensory and motor block, duration of analgesia, adverse effects and haemodynamic status were monitored. Statistical analysis was done using t-test and Chi-square test. Results: The demographic variables, onset of sensory and motor block were comparable in both the groups. Mean duration of sensory block in group A and B were 638.08±52.001 minutes and 568.85±36.478 minutes respectively. The mean duration of motor block in group A was 605.77±58.8 minutes and group B was 513.46±14.982 minutes. The mean duration of analgesia in group A and B were 722.3±58.13 and 615.00±48.19 minutes, respectively. Mean duration of sensory block, motor block and analgesia were found more in group A which was statistically significant with p-value=<0.05. There was no significant difference in haemodynamic parameters. Conclusion: Dexmedetomidine was a better adjuvant to 0.5% ropivacaine as compared to fentanyl in Ultrasound-guided supraclavicular brachial plexus block in terms of duration of sensory block, motor block and analgesia.

Comparison of efficacy of nalbuphine-levobupivacaine combination with levobupivacaine alone in ultrasound-guided supraclavicular brachial plexus block in upper limb orthopedic surgeries

Abstract Background and Aims: Brachial plexus block is a widely used approach for upper limb surgeries as an alternative to general anesthesia to achieve ideal operating conditions by providing adequate muscle relaxation and maintaining intraoperative hemodynamic stability. Ultrasound-guided supraclavicular brachial plexus block provides intraoperative anesthesia and postoperative analgesia. It reduces many complications such as intravascular injection pneumothorax. Levobupivacaine is preferable over bupivacaine due to its lower cardiotoxicity, prolonged sensory block, and shorter duration of motor block. Materials and Methods: A prospective, hospital-based, double-blinded, randomized, controlled, comparative study was planned on 80 adult patients of either sex belonging to the American Society of Anesthesiologists Class 1 and 2 undergoing upper limb orthopedic surgeries. Group L – 24 mL levobupivacaine 0.375% (90 mg) + NS (1 mL) (total volume 25 mL) and Group LN – 24 mL levobupivacaine 0.375% (90 mg) +5 mg nalbuphine diluted with NS to 1 mL volume (total volume 25 mL). Duration of analgesia, onset, and duration of sensory block and motor block, hemodynamic changes, and total doses of rescue analgesia in 24 h were noted in both groups. Results: The duration of analgesia was significantly longer in Group LN (749.80 ± 9.70 min) as compared to Group L (641.20 ± 12.71 min) (P < 0.001). Onset of sensory block in Group LN (11.15 ± 0.83 min) is faster than in Group L is (13.30 ± 0.52 min) (P < 0.001). Onset of motor block in Group LN (13.68 ± 0.73 min) is faster than in Group L (16.33 ± 0.89 min) (P < 0.001). Hemodynamic parameters were comparable in both groups. There was no significant difference in adverse effects and complications. Conclusion: The addition of nalbuphine to levobupivacaine provides a longer duration of analgesia as compared to levobupivacaine alone.

Risk factors for insufficient ultrasound-guided supraclavicular brachial plexus block

PurposeUltrasound-guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements.MethodsIn total, 269 patients receiving ultrasound-guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut-off values with the highest predictive potential.ResultsOf 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139–171) mmHg vs. 145 (127–155) mmHg; P = 0.026].ConclusionElbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement.Level of EvidencePrognostic Level III

Effect of Two Different Volumes of Ropivacaine and Lignocaine at Two Different Sites in Ultrasound-Guided Supraclavicular Brachial Plexus Block on Diaphragm Motility

Ultrasound (USG) guided supraclavicular brachial plexus block (BPB) helps in precise delivery of local anesthetic injection, reduced volume or dose of drug providing excellent surgical anesthesia with fewer complications. Objective of the study was to compare effect of two different volumes of Ropivacaine and Lignocaine at two different sites of USG-guided supraclavicular BPB on diaphragmatic motility, quality of block and tourniquet pain. A prospective randomized double-blinded comparative study was conducted among adult patient with below elbow elective surgery. In group A patients (n=17), 20ml of anesthetic solution was injected in the corner pocket and 10ml in the nerve cluster guided with USG. In group B patients (n=17), 15ml of the anesthetic solution was injected in the corner pocket and 5ml in the nerve cluster guided with USG. Hemodynamic parameters, diaphragmatic excursion, onset of anesthetic effects were measured at frequent intervals. The data were analyzed using Statistical Package for Social Sciences at P-value less than 0.05. Hemodynamic profile of the patients were similar in both groups (P-value>0.05). Statistically significant hemi-diaphragmatic dysfunction (partial and complete paralysis) after 15 and 30minutes of blockade was more common in group A than Group B (P<0.05). At 30 minutes after the injection of the anesthesia, all patient in both the groups had complete sensory and motor block in all nerve territory. Tourniquet time was lower in group A (80.35±9.59 minutes vs 84.12±7.75 minutes); however, it was statistically not significant (P-value>0.05). The present study showed that the patients who received lesser half of the required volume of local anesthetics had less incidence of hemidiaphragmatic dysfunction with similar successful rate of blockage (100%) and similar quality of the block as compared to the patients who received greater half of the required volume of local anesthetics.

Perfusion Index after Supraclavicular Brachial Plexus Block as an Early Predictor of Successful Block

Objective: Supraclavicular brachial plexus block is a highly popular upper extremity anesthetic technique. Theoretically, after local anesthetic agent is injected, temporary vasodilatation, sensory loss and motor weakness ensue. The assessment of successful block relies on subjective data of sensory block and patient co-operation. The present study hypothesized that perfusion index (PI) is an early predictor and provide a cut-off value for the successful block. Materials and Methods: Sixty-two patients undergoing upper extremity operation under ultrasound-guided supraclavicular brachial plexus block were included. PI values were assessed on the operated limb at baseline, 0, 1, 3, 5, and 10 minutes after block. The patients were divided into three groups. Upon incision, patients that reported pain but tolerated the operation after anesthetic supplement were in the supplement group, patients that reported persistent pain after anesthetic supplement were in the failed group, and patients that did not required any supplement were in the complete group. The three groups were monitored with PI values. Results: The supraclavicular brachial plexus block of fifty-nine patients (95.16%) were successfully blocked, which 42 patients (67.74%) had complete block and 17 patients (27.42%) needed supplemental treatment. Three patients (4.84%) had failed block and were converted to general anesthesia. The PI value was continuously rising from baseline in successfully blocked patients. PI value at three minutes after local anesthetic injection showed block success at cut-off value of 3.6, respectively. Conclusion: Successful block could be determined early by the increase of PI value from baseline. A PI value of more than 3.6 at 3-minute after block is a good early predictor of successful block. Keywords: Perfusion index; Ultrasound-guided regional anesthesia; Brachial plexus block; Supraclavicular block; Regional anesthesia; Peripheral anesthesia

Low-Concentration Brachial Plexus Block

We devised a low-concentration brachial plexus block (LCBB) that allows for intraoperative, active motion by blocking only sensory nerves. This study evaluated the efficacy of the LCBB. Thirty-eight patients (14 men and 24 women; mean age, 60.0 years) underwent surgery with the LCBB. An ultrasound-guided supraclavicular brachial plexus block with 30-40 mL of 0.6 mg/ml ropivacaine hydrochloride hydrate was performed approximately 2hours before starting the surgery. A local anesthetic (LA) was administered as a local infiltration if the intraoperative pain relief was locally insufficient. The surgery was performed using a tourniquet as usual, which was released for approximately 1 minute when there was a requirement to check for intraoperative, active motion. We recorded the waiting time required between LCBB administration and surgery, the total surgery time, the total tourniquet time, the number of patients administered an LA, the total LA volume (1% lidocaine equivalent), and the muscle strength at intraoperative, active motion (evaluated by manual muscle testing and categorized as ≥grade 4 or ≤grade 3). The mean waiting time was 137.0 minutes, the mean surgery time was 124.6 minutes, and the mean tourniquet time was 70.6 minutes. In 2 patients, the anesthetic effect was not achieved, and we switched to other methods of anesthesia (1 patient was switched to an intravenous, regional anesthesia; 1 patient was switched to a standard brachial plexus block). Excluding those 2 cases, the mean LA volume was 8.7 mL among 22 cases (61.1%), and 33 cases (91%) had manual muscle testing of ≥grade 4. In 36 of 38 cases (94.7%), surgery could be performed by LCBB. Although an LCBB may require additional LA, it is a useful anesthesia method that allows intraoperative active motion and tourniquet use. Therapeutic IV.

Low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia: a randomized controlled trial

PurposeDexmedetomidine has been proposed as an additive to local anesthetics to prolong peripheral nerve block duration; however, perineural dexmedetomidine has been associated with an increased risk of bradycardia and hypotension This randomized controlled study investigated the effects of low-dose dexmedetomidine as a perineural adjuvant for postoperative analgesia.MethodsFifty-five patients who had undergone elective upper extremity surgery were randomized to receive an ultrasound-guided supraclavicular brachial plexus block with 20 mL 0.5% ropivacaine with or without 30 μg dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included the onset time and duration of the motor and sensory blocks, incidence of hypotension and bradycardia, total postoperative analgesics, and safety assessment during the 24 h after surgery.ResultsDexmedetomidine significantly prolonged the duration of analgesia (887 ± 92 min vs 661 ± 83 min, P < 0.0001). The onset time and the duration of motor and sensory block were significantly different between the groups (all P < 0.001). No episodes of hypotension or bradycardia were detected in the dexmedetomidine group. The total postoperative analgesic use and side effect profiles in the first 24 h postoperative period were similar for both groups.ConclusionsLow-dose dexmedetomidine (30 μg) as a perineural adjuvant significantly prolonged the analgesic duration of a brachial plexus block without inducing hemodynamic instability.Trial registrationThis trial was registered at ClinicalTrial.gov (NCT02630290).

Impact of an extrafascial versus intrafascial injection for supraclavicular brachial plexus block on respiratory function: a randomized, controlled, double-blind trial

IntroductionHemidiaphragmatic paresis after ultrasound-guided supraclavicular brachial plexus block is reported to occur in up to 67% of patients. We tested the hypothesis that an injection outside the brachial plexus sheath...

Comparison of Postoperative Duration of Analgesia in Patients Receiving Supraclavicular Brachial Plexus Block with and without Dexmedetomidine

Introduction: For upper-limb orthopaedic surgery, supraclavicular brachial plexus block is routinely used and involves administering bupivacaine to the supraclavicular plexus. Recent studies claimed that the addition of dexmedetomidine to bupivacaine for supraclavicular brachial plexus block significantly prolonged the mean duration of postoperative analgesia. This study was necessitated by the fact that existing evidence was limited and there was no local published material to support the findings. Objective: The objective of this study was to compare the postoperative duration of analgesia in patients receiving supraclavicular brachial plexus for upper limb surgeries block with and without dexmedetomidine. Methods: This study was performed at the Department of Anesthesiology Lahore General Hospital, Lahore using randomized controlled trial. In this study, sixty patients between the ages of 18 and 60 and from both genders who underwent ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgery were randomly and equally divided into two treatment groups. The patients of Group-A received bupivacaine along with dexmedetomidine while those in Group-B received bupivacaine with normal saline for the block. Mean postoperative analgesia duration in minutes up to a VAS &gt; 3 was the outcome variable. Each patient signed informed consent before the study. Results: The patients' average age was 38.4±14.1 years and 37 (61.7%) were male and 23 (38.3%) were female. The significantly longer mean duration of postoperative analgesia (754.27±144.89 vs. 441.80±111.38 minutes with p-value less than 0.001) was observed in patients receiving dexmedetomidine in addition to bupivacaine as compared to bupivacaine alone. This significant mean duration was also recorded in various subgroups of age, gender, BMI, and duration of surgery. Conclusion: The superiority of the combination of dexmedetomidine with bupivacaine was reported as compared to the conventional practice of bupivacaine alone in terms of significantly prolonged mean duration of postoperative analgesia. This novel combination may reduce the need for postoperative opioids and recommend it for future anesthetic practice. Keywords: Supraclavicular Brachial Plexus Block, Dexmedetomidine, Post-Operative Analgesia