Efficacy and Safety of Ultrasound-Guided Supraclavicular Brachial Plexus Block during Angioplasty of Dysfunctional Arteriovenous Access: A Prospective, Randomized Single-Center Clinical Trial

Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block.Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher’s exact test.Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block.Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.

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A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0008 ◽

2016 ◽

Vol 1 (1) ◽

pp. 30-31

Author(s):

Sindil Kumar Sahu ◽

Usha Badole

Keyword(s):

Brachial Plexus ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Brachial Plexus Block ◽

Rare Complication ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Ultrasound Guided ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

ABSTRACT Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block. How to cite the article Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.

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A comparative clinical study of perineural administration of 0.75% ropivacaine with and without dexmedetomidinein upper limb surgery by ultrasound guided single injection supraclavicular brachial plexus block

Global Anesthesia and Perioperative Medicine ◽

10.15761/gapm.1000133 ◽

2015 ◽

Vol 1 (5) ◽

Cited By ~ 3

Author(s):

Prashant Tiwari ◽

Manish ain ◽

Bhawana Rastogi ◽

Salony aggarwal ◽

Kumkum Gupta ◽

...

Keyword(s):

Clinical Study ◽

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Single Injection ◽

Ultrasound Guided ◽

Upper Limb Surgery ◽

Comparative Clinical Study ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

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Effect of Midazolam and 0.5% Levobupivacaine Combination in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries - A Clinical Study

The Open Anesthesiology Journal ◽

10.2174/1874321801610010027 ◽

2016 ◽

Vol 10 (1) ◽

pp. 27-33

Author(s):

Bhawana Rastogi ◽

Ankush Arora ◽

Kumkum Gupta ◽

Manish Jain ◽

Vijendra Pal Singh ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Motor Blockade ◽

Ultrasound Guided ◽

End Points ◽

Supraclavicular Brachial Plexus Block ◽

Vas Scores ◽

The Mean ◽

Plexus Block

Background: The present study was designed to evaluate the hypothesis that midazolam as an adjuvant to levobupivacaine would safely enhance the duration of analgesia without any adverse effects when compared with levobupivacaine alone, in ultrasound-guided supraclavicular brachial plexus block. Primary end points were the duration of sensory and motor block and secondary end points were sedation score and any other complications. Patients and Method: Eighty consenting patients of both sexes, aged 18-60 years of ASA physical status I-II were randomized into two groups of 40 patients each. Patients in Group LS received 19 ml of 0.5% levobupivacaine with 1 ml normal saline and patients in Group LM received 19 ml of 0.5% levobupivacaine with 1ml midazolam (50µg/kg) for supraclavicular brachial plexus block using ultrasound guidance. Onset time and duration of sensory and motor blockade and VAS scores were assessed as primary end points. Hemodynamic changes, sedation or any other drug or technique related adverse effects were taken as secondary effects. Results: Onset of sensory and motor blockade was lower in patients of Group LM. The mean duration of sensory analgesia was significantly prolonged in patients of Group LM (537.6 ± 101.01 vs. 319.80 ± 87.09 mins). The mean duration of motor blockade was also significantly enhanced in patients of Group LM (405.0 ± 61.62 mins) compared to Group LS (274.8 ± 46.30 mins). VAS scores were higher in Group LS than group LM. Sedation scores were similar in both the groups. Conclusion: Midazolam with 0.5% levobupivacaine has effectively enhanced the duration of sensory and motor block without significant sedation and any other side effect.

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