Ultrasound-guided Supraclavicular Brachial Plexus Block Research Articles

Comparative study between the use of bupivacaine alone or with nalbuphine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries

Background Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. Objective To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique. Patients and methods This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block. Results The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block. Conclusion Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.

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

Clinical Evaluation of Two Different Doses of Clonidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Pediatric Upper Limb Surgeries - A Randomized Trial

Clonidine as an adjuvant to local anesthetic for regional anesthesia in upper limb surgeries has been extensively studied in adults, but there is a paucity of data regarding the dose of clonidine which is effective and safe as an adjuvant in children. To find the dose of clonidine that prolongs the duration of analgesia without prolonging the side effects. Prospective, randomized, double-blind study. After taking informed consent from the parents/guardian, 42 children aged 3-12 years who were scheduled to undergo unilateral upper limb surgeries below the elbow were randomized into two groups of 21 each. Group A was given 0.5 μg.kg-1 of clonidine in addition to 0.5 mL.kg-1 of 0.25% bupivacaine and Group B received 1 μg.kg-1 of clonidine added to the same volume and concentration of local anesthetic for supraclavicular brachial plexus block under general anesthesia using ultrasound guidance. The drug administration and the recording of the observations were done by an investigator blinded to the dose of clonidine. Statistical testing was conducted with the Statistical Package for the Social Sciences system version SPSS 17.0. The demographic parameters and baseline hemodynamic parameters were similar in the two groups. The block failed in one child in Group A. One patient in Group A required tramadol postoperatively while none of the patients in Group B required tramadol. The mean duration of analgesia (11.35 ± 1.54 h vs. 9.94 ± 1.04 h, P < 0.001) and the duration of motor block (8.86 ± 1.0 h vs. 7.77 ± 0.55 h, P < 0.001) were significantly higher in group B. Sedation scores were higher in the recovery room in Group B. Deep sedation, bradycardia, and respiratory depression were not observed in any of the cases. Clonidine 1 μg.kg-1 when added as an adjuvant to bupivacaine for pediatric supraclavicular brachial plexus block prolongs the duration of analgesia and motor block as compared to the dose of 0.5 μg.kg-1. However, this was at the cost of increased duration of motor block and sedation. Considering the clinical equivalence of the effect, a lower dose of clonidine would be preferable to avoid the undesirable effects.

Role of an Intercostobrachial Nerve Block in Alleviating Tourniquet Pain: A Randomized Clinical Trial.

IntroductionTourniquet pain may have cutaneous and ischemic components. It is questionable whether blockade of a sensory nerve will help reduce ischemic pain. In addition, complete anesthesia of the axilla in the intercostobrachial nerve (ICBN) distribution is challenging to execute, and ICBN blockade has an inherently higher failure rate because of its variable anatomic location and source of innervation. We sought to determine the utility of an ICBN block for the prevention of tourniquet pain.MethodsWe conducted a single-center randomized controlled trial at a major academic medical center involving patients scheduled to undergo distal upper extremity surgery under ultrasound-guided supraclavicular brachial plexus block. Forty patients were randomized to receive an additional ICBN block or no ICBN block, with 22 allocated to the intervention and 18 to control. We collected data on the incidence of tourniquet pain and systemic anesthetic requirements.ResultsInitial contingency analysis examining the relationship between ICBN block placement and the development of pain using the two-tailed Fisher exact test failed to show that the presence or absence of ICBN block was associated with the development of tourniquet pain. χ2 analysis failed to show that tourniquet time was significantly related to the development of tourniquet pain.ConclusionsThe overall incidence of tourniquet pain in the setting of a dense supraclavicular brachial plexus block for surgical anesthesia was low even without an ICBN block and even with tourniquet times greater than 90 min. Tourniquet pain was easily managed with small amounts of systemic analgesics.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

BackgroundUltrasound-guided intertruncal approach (IA) to the supraclavicular block (SB) is recently proposed as a new approach for local anesthetic (LA) injection in terms of the classical approach (CA) at the level of the first rib. The CA-SB has been proven to result in satisfying sensorimotor block, but associate with a high risk of intraneural injection. The aim of this randomized non-inferiority study is to explore whether IA-SB can obtain similar block dynamics, as the CA-SB, but avoiding an intraneural injection during the whole nerve block procedure.MethodsThe total 122 patients undergoing elective upper extremity surgery will be randomly allocated to receive either an IA-SB or a CA-SB using a double-injection (DI) technique. In the IA-SB group, a portion of LA (15 mL) is injected accurately to the intertruncal plane between the middle and lower trunks under real-time ultrasound guidance; then, the remaining volume (10 mL) is carefully distributed to the other intertruncal plane between the upper and middle trunks. In the CA-SB group, the DI technique will be carried out as described in Tran’s study. The primary outcome is the percentage of patients with a complete sensory blockade at 20 min with a predefined non-inferiority margin of − 5%. The secondary outcomes include the sensory-motor blockade of all 4 terminal nerves, onset times of the individual nerves within 30 min, block-related variables, and adverse events.DiscussionThe results will provide sensory-motor blockade-related parameters and safety of the ultrasound-guided intertruncal approach to the supraclavicular block, thereby promoting clinical practice.Trial registrationChinese Clinical Trial Registry ChiCTR2000040199. Registered on 25 November 2020

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objectives: Ultrasound-guided supraclavicular brachial plexus block is the most commonly performed approach for the upper limb surgeries and perioperative pain relief. This study was conducted to compare the post-operative analgesic efficacy of dexmedetomidine and clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a prospective, randomized, and double-blinded comparative research that included 60 ASA PS I and II patients who were scheduled for the upper limb surgery. The patients were randomized into two groups, namely, Group C and Group D, with 30 patients each. The patients in Group D were given USG-guided supraclavicular brachial plexus block with 30 ml of 0.5% ropivacaine and dexmedetomidine 1 μg/kg and patients in Group C received 30 ml of 0.5% ropivacaine and clonidine 1 μg/kg. The patients were monitored for post-operative and interpreted by visual analog score and duration of analgesia. The Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever is appropriate, was applied for comparing categorical variables. Results: The mean duration of analgesia was longer and the mean consumption of rescue analgesics was lower in Group D as compared to Group C. No significant post-operative complications or local side effects related to the block were noted. Conclusion: Dexmedetomidine prolongs the duration of sensory and motor block as well as the duration of post-operative analgesia as compared to clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study.

Objectives:To compare the postoperative analgesia efficacy of dexamethasone added to low-dose high-volume bupivacaine in ultrasound-guided supraclavicular brachial plexus block for adult patients who underwent upper limb orthopedic surgeries at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia.Methods:An observational prospective cohort study was conducted from 1 September 2021 to 30 January 2022. Using a systematic random sampling technique, 56 patients (equal groups of 28 patients) aged 18–60 years scheduled for elective upper limb orthopedic surgeries under supraclavicular block were recruited. According to the discretion of anesthetists’ management plan of supraclavicular block, those patients who received 38 mL of 0.25% bupivacaine with 2 mL (8 mg) dexamethasone as the case group (DB) while those patients who received 40 mL of 0.25% bupivacaine alone as the cohort group (B). Time to first analgesic request, onset of sensory and motor, and motor block duration were analyzed with Student’s t-test whereas pain severity and analgesic consumption were assessed using the Mann–Whitney U test. Categorical variables were analyzed using chi-square test. p-value less than 0.05 considered statistically significant.Results:Postoperative analgesia had significantly prolonged in the dexamethasone bupivacaine group with a mean duration of 1098.00 ± 195.90 min compared to 464.29 ± 113.75 min in the bupivacaine alone group, p-value < 0.001. Moreover, the dexamethasone bupivacaine group significantly consumed less total tramadol and diclofenac than bupivacaine alone, with a median dose of 0 (0–50) versus 50 (21.25–78.75) mg and 40 (0–50) versus 65 (47.50–77.50) mg, respectively. The median visual analogue scale scores were significantly reduced at 6th, 8th, 12th, and 24th hour in the dexamethasone bupivacaine group.Conclusion:Dexamethasone added to low-dose high-volume of bupivacaine in supraclavicular brachial plexus block significantly prolonged the duration of analgesia.

Comparing the efficacy of ultrasound-guided supraclavicular brachial plexus block with or without intercostobrachial nerve block for forearm surgeries – An observational study

Background: Supraclavicular block is a commonly used block for regional anesthesia in forearm surgeries. The rationale behind this study is to prove that ultrasound (USG)-guided supraclavicular block is sufficient to provide adequate analgesia and eliminates the need for an intercostobrachial (ICB) block for forearm surgeries. Aim: We aimed to find whether there is any additional advantage in performing ICB block along with supraclavicular brachial plexus block in forearm surgeries. Methods: In this study, 110 patients undergoing elective forearm surgeries under USG-guided supraclavicular block were observed. A block solution of 30 ml was made and 20 ml was given as supraclavicular block. Group ICB, received an additional 10 ml ICB nerve block (ICBN) and group Non-ICB who did not receive an additional block. The outcomes assessed were intraoperative and postoperative tourniquet pain scores, hemodynamic changes, the onset of sensory and motor block, sensory and motor scoring, postoperative rescue analgesia time, and patient satisfaction. Data were analyzed using SPSS 25.0 version. Results: The mean intraoperative and postoperative pain scores in the group ICB was 0.76 ± 1.677 and in the non-ICB was 0.69 ± 1.439 and was no significant. Furthermore, there was no statistically significant difference between the immediate and late postoperative pain scores between the two groups. Conclusion: Our study has concluded that a sole USG-guided supraclavicular block provides adequate anesthesia of the operated forearm. Additional blocking of the ICBN does not affect the incidence or course of tourniquet pain.

Comparing Different Doses of Dexmedetomidine Combined with Ropivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries - A Prospective Randomized Controlled Trial.

Background:Dexmedetomidine is used as an adjuvant to local anesthetic agents to provide prolonged analgesia in peripheral nerve blocks. This study aimed at determining the optimal dose of dexmedetomidine, which when combined with ropivacaine will produce a superior quality block in terms of extended pain-free period and reduced perioperative analgesic/opioid use, which in turn improves patient satisfaction.Objective:The objective of the study is to assess the duration of analgesia with two different doses (25 μg and 50 μg) of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block.Subjects and Methods:This prospective randomized controlled study included 50 patients undergoing upper limb surgeries under supraclavicular brachial plexus block randomly divided into two groups. Group D25 received 29 mL of 0.5% ropivacaine +25 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL); Group D50 received 29 mL of 0.5% ropivacaine +50 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL). Onset and duration of sensorimotor block, duration of analgesia, and time interval for the rescue analgesia and hemodynamic stability were observed.Results:The mean onset of motor and sensory block was significantly higher in the D25 group (P = 0.001). The Visual Analog Scale pain scores and rescue analgesia consumption were significantly lower in the D50 group (P = 0.013, 0.001). The duration of analgesia was significantly higher in the D50 group (P = 0.001).Conclusion:Dexmedetomidine 50 μg is an effective adjuvant dose to ropivacaine with insignificant hemodynamic changes with better duration of analgesia and lesser pain scores.

A prospective randomized comparative study of dexmedetomidine versus clonidine as an adjunct to 0.75% ropivacaine in ultrasound-guided supraclavicular brachial plexus block

Introduction Alpha-2 agonists are popular adjuvants used in neuraxial anesthesia like spinal, epidural, caudal anesthesia, and peripheral nerve blocks. The authors compared the efficacy of clonidine with dexmedetomidine as an adjuvant to ultrasound (US)-guided supraclavicular brachial plexus block in adult patients undergoing elective upper limb surgeries. Materials and methods After obtaining Ethics Committee approval, 60 American Society of Anesthesiologists’- physical status (ASA-PS) I/II patients were randomized into two groups. Group Clonidine-Ropivacaine (CR) received 1 μg/kg clonidine as an adjuvant and group Dexmedetomidine-Ropivacaine (DR) received 1 μg/kg dexmedetomidine. Patients received an ipsilateral US-guided supraclavicular brachial plexus block with 0.75% ropivacaine (total volume of 20 ml). Demographic data, hemodynamics, the onset of block (sensory, motor), the duration of block (sensory, motor), duration of analgesia and surgery, total number of rescue analgesics, numerical rating scores, and Ramsay sedation score were compared between both groups using appropriate statistical tests. Results Heart rates at 30 min, 60 min, 2 h, and 3 h were lower in group DR compared with group CR, which was statistically significant (P=0.0001, 0.0001, 0.021, and 0.026, respectively). The onset of sensory and motor block, duration of sensory and motor block, and duration of analgesia were better in group DR compared with CR, which was statistically significant (P=0.00). The number of rescue analgesics required in group CR in both groups was comparable (P=0.057). Numeric rating scale scores at 12, 18, and 24 h were significantly better in group DR compared with group CR (P=0.0001, 0.039, and 0.036, respectively). Conclusion When added as an adjuvant to 0.75% ropivacaine in the US-guided supraclavicular brachial plexus, dexmedetomidine block produced faster onset of sensory and motor blockade, prolonged the duration of sensory and motor blockade, and also prolonged the duration of analgesia, when compared with clonidine.

A Comparative Study of Effect of 0.25% Levobupivacaine with Dexmedetomidine versus 0.25% Levobupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block.

Context:Dexmedetomidine, an α2-agonist, has been studied widely as an adjuvant to local anesthetics in regional anesthesia techniques to enhance the quality and duration of analgesia (DOA). It was hypothesized that addition of dexmedetomidine 0.5 ug.kg‒1 to levobupivacaine would prolong the DOA.Aims:We aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor blockade, and duration of analgesia.Settings and Design:This was a prospective randomized double-blind study carried out at a tertiary hospital attached to medical college.Subjects and Methods:Sixty American Society of Anesthesiologists PS Class I and II patients aged between 18 and 60 years of either sex, undergoing elective upper-limb surgery lasting more than 30 min, were included in the study. They were randomly divided into two groups of thirty each to receive ultrasound-guided supraclavicular brachial plexus block. Group L was given nerve block with 20 mL of 0.25% levobupivacaine and 1 mL saline, and Group D received 20 mL of 0.25% levobupivacaine with 0.5 ug.kg‒1 of dexmedetomidine (diluted to volume of 1 mL). Onset time and duration of sensory and motor blockade, time to first rescue analgesia, and hemodynamic parameters were recorded.Statistical Analysis Used:Chi-square test for qualitative variables and Student's unpaired “t“ test for continuous variables were used for statistical analysis.Results:The onset of sensory and motor blockade was 6.51 ± 0.77 min and 10.71 ± 0.34 min in Group D and 9.9 ± 0.45 and 15.93 ± 1.92 min in Group L, respectively (P < 0.005). DOA was 9.53 ± 0.29 h in Group D and 3.89 ± 0.30 h in Group L (P < 0.001). The duration of sensory and motor block was 9.14 ± 0.19 h and 8.55 ± 0.31 h in Group D and 6.15 ± 3.02 and 5.61 ± 2.98 h in Group L, respectively (P < 0.005). No adverse effects were observed in either of the groups.Conclusions:Addition of 0.5 ug.kg‒1 of dexmedetomidine to 20 mL 0.25% levobupivacaine in ultrasound guided (USG)-guided supraclavicular brachial plexus block shortens the onset time of sensory and motor blockade and prolongs duration of sensory and motor block and DOA.

A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery

A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery

Pulse Oximeter Perfusion Index as a Predictor of Successful Supraclavicular Brachial Plexus Block

Abstract Objective Ultrasound-guided supraclavicular brachial plexus block is a popular anesthetic technique for upper limb surgeries. Assessing the success sensory and motor block using conventional methods is time consuming and also it needs patient co-operation. In the present study, objective method like increase in perfusion index is used to predict the success of ultrasound-guided supraclavicular block. Materials and Methods This prospective trial consists of total 95 patients undergoing elective upper limb procedures. All patients received ultrasound-guided supraclavicular block using 0.5% bupivacaine 20 mL. Sensory and motor blocks were evaluated every 5 minutes followed by pinprick testing and ability to flex the elbow and the hand against gravity, respectively. The perfusion index was measured using pulse oximetry applied on the index finger and recorded at baseline and 10, 20, and 30 minutes interval after local anesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate pulse oximeters. Results Perfusion index increased in blocked arm after 5 minutes compared with unblocked arm and also to its baseline value. Both perfusion index and perfusion index ratio in blocked arm were found statistically significant. Conclusion To evaluate the success of supraclavicular block, perfusion index can be considered as a useful tool.

Fentanyl versus tramadol as an adjunct to bupivacaine in ultrasound-guided supraclavicular brachial plexus blockade: pros and cons

Background & objective: There have been a lack of consensus among the anesthetists regarding the utility of different opioids as adjuvants in brachial plexus blockade (BPB). The results vary and there is no agreement. We studied the utility of fentanyl versus tramadol as an adjunct to local anesthetic bupivacaine in ultrasound-guided supraclavicular BPB. Methodology: The study was conducted on 71 patients who were randomized in three groups for ultrasound-guided supraclavicular brachial plexus block. Group B: received 20 ml bupivacaine 0.5% plus fentanyl (100 µg = 2 ml); Group T: received 20 ml bupivacaine 0.5% plus tramadol (100 mg - 2 ml). Data was collected for the onset and duration of sensory and motor block, time to first request for rescue analgesia and the total analgesic consumption in first 24 h postoperatively. Results: There was a significantly shorter time to the onset of sensory blockade (p = 0.001) and motor blockade (p = 0.001) in Group T compared to Group B and Group F (p = 0.045 and p = 0.001, respectively). The time to first analgesic requests was significantly longer in the tramadol and fentanyl groups than in the bupivacaine group (p = 0.001 and p = 0.021, respectively) and significantly longer in the tramadol group compared to the fentanyl group (p = 0.041). Conclusion: Tramadol as an adjuvant to bupivacaine in ultrasound-guided supraclavicular BPB produces a significantly prolonged analgesia with a shorter onset of sensory and motor blockade. Key words: Adjuvants; Analgesia; Bupivacaine; Fentanyl; Tramadol; Ultrasound-guided supraclavicular block Abbreviations: BPB – brachial plexus blockade; VAS – visual analog scale; MBP – mean blood pressure; HR – heart rate; SpO2 – peripheral oxygen saturation; LSD – test Least Significant Difference test Citation: Ghazaly HF, Eldemrdash AM, Atito BE, Abdelrheem SS, Aly AAA. Fentanyl versus tramadol as an adjunct to bupivacaine in ultrasound-guided supraclavicular brachial plexus blockade: pros and cons. Anaesth. pain intensive care 2021;25(4):450–457. DOI: 10.35975/apic.v25i4.1565 Received: March 17, 2021. Reviewed: May 23, 2021. Accepted: June 17, 2021