A comparative study between Bupivacaine volumes on diaphragmatic mobility in Ultrasound guided Supraclavicular Block

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Israa Tarek Mohamed Abdelaziz ◽  
Ahmed Nagah El shaer ◽  
Tamer Yousef Elie ◽  
Wael Abd Elaziz Mohamed
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Intravascular Injection ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Supraclavicular Block ◽  
Plexus Block

Abstract Background Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. Objective To compare the effect of two different volumes of bupivacaine (20 ml and 25 ml) on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. Group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially. Results Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion. Conclusion Assessment of diaphragmatic excursion is the best indication of phernic nerve injury after supraclavicular block. The use of the ultrasonography is the fastes, easiest and safest method for this assessment. The use of ultrasonography in performing the supraclavicular nerve block decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

Dexamethasone as an Adjuvant to 0.5 % Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block

2021 ◽  
Vol 8 (14) ◽  
pp. 849-853
Author(s):  
Shweta Saurin Mehta ◽  
Nidhiben Sureshbhai Patel
Keyword(s):  
Adverse Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Supraclavicular Approach ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Regional Anaesthetic Technique ◽  
Plexus Block

BACKGROUND Supraclavicular brachial plexus block is a reliable, regional anaesthetic technique for upper limb surgeries. Also known as “spinal of upper limb”.1 The present study was conducted to assess the analgesic efficacy of dexamethasone as an adjuvant to 0.5 % ropivacaine for ultrasound sonography (USG) guided brachial plexus block. METHODS 50 adult patients of American Society of Anaesthesiologists (ASA) physical status I and II of both genders, aged 18 - 50 years scheduled for elective upper limb surgeries under brachial plexus block via supraclavicular approach were randomised into 2 groups of 25 patients each to receive either 20 ml of 0.5 % ropivacaine with 2 ml of normal saline (group A) or 20 ml of 0.5 % ropivacaine with 2 ml of dexamethasone (8 mg) (group B). RESULTS Use of ultrasound helps in better visualisation of nerves, needle & spread of local anaesthetic at brachial plexus block site. So, less amount of drug volume is required for the block. Time of onset of sensory and motor block was significantly lower in group B compared to group A. Mean duration of motor and sensory block was significantly longer in group B than group A. The duration of postoperative analgesia was 18.79 ± 2.31 hours in group B & 9.06 ± 0.35 hours in group A, with statistically highly significant difference (P < 0.05). There were no perioperative haemodynamic variations between the two groups and no complication of technique or adverse effects due to dexamethasone occurred. CONCLUSIONS Dexamethasone 8 mg has significantly extended duration of analgesia of brachial plexus block with no adverse effects. KEYWORDS Brachial Plexus Block, Ropivacaine, Dexamethasone, Supraclavicular Approach, Ultrasound Guidance

scholarly journals A Comparative Study of Efficacy of Clonidine and Dexmedetomidine As An Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block Vis-À-Vis Onset of Surgical Anaesthesia and Duration of Effect in Upper Limb Surgeries

2020 ◽  
Vol 8 (8) ◽  
pp. 513
Author(s):  
Sandeep Dubey ◽  
Rukhsana Najeeb ◽  
Arshid Ahmad Sofi
Keyword(s):  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
P Value ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background: Supraclavicular block is a safe, reliable and cost effective technique of providing anesthesia for the upper limb surgeries. Objectives:  To evaluate the effect of Clonidine and Dexmedetomidine as an adjuvant to Ropivacaine in ultrasound guided supraclavicular block in upper limb surgeries with respect to: Onset of sensory and motor block, Duration of sensory and motor block, Quality of block and Duration of post-operative analgesia. Materials and methods: The purpose of present study was to compare the effect of addition of clonidine 1mcg/kg vs dexmedetomidine 1mcg/kg to 20ml of 0.5% ropivacaine in ultrasound guided supraclavicular brachial plexus block. A total of 90 patients of ASA I and II, aged 18-60 years, of either gender, undergoing upper limb surgery were allocated to three groups. Each group consisted of 30 patients. They received drugs as under: Group-A (dexmedetomidine group) received 20ml of 0.5% ropivacaine plus 1μg/kg of dexmedetomidine. Group-B (clonidine group) received 20ml of 0.5% ropivacaine plus 1mcg/kg clonidine. Group-C (placebo group) received 20 ml of 0.5% ropivacaine plus 2 ml normal saline. Results: Onset of sensory block was faster in Group-A as compared to Group-B and Group-C. The difference was statistically significant (p-value<0.05). Onset of motor block was faster in Group-A as compared to Group-B and Group C. The difference was statistically significant (p-value<0.05). Patients of Group-A had significantly longer duration of sensory and motor block when compared with Group-B and Group-C (p-value<0.05). Duration of post-operative analgesia was significantly longer in Group-A as compared to Group-B and Group-C (p-value<0.05). Quality of block was significantly better in Group-A as compared to Group-B and Group-C (p-value<0.05). Conclusion: Dexmedetomidine prolongs the duration of sensory and motor block, duration of postoperative analgesia and improves the quality of block much more as compared to clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

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

2021 ◽  
Author(s):  
Karthik S. L. ◽  
Vishwanath Ankad ◽  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Prospective Trial ◽  
Perfusion Index ◽  
Ultrasound Guided ◽  
Study Objective ◽  
Supraclavicular Brachial Plexus Block ◽  
Supraclavicular Block ◽  
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.

scholarly journals Effectiveness of Nalbuphine with Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

2021 ◽  
Vol 15 (7) ◽  
pp. 1791-1793
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
P Value ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Objective: To investigate the effectiveness of ropivacaine in supraclavicular brachial plexus block by nalbuphine and compare it to ropivacaine alone. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Fatima Memorial Hospital/College of Medicine & Dentistry, Lahore from 1st June 2020 to 31st March 2021. Methods: Ninety six patients of both genders with ages 20 to 65 years undergoing upper limb surgical procedure electively were included. All the patients were divided equally in to two groups, each group consist of 48 patients. Group A treated with ropivacaine with nalbuphine and group B treated with ropivacaine normal saline. Effectiveness between both groups was examined. Results: No significant difference was observed regarding age, gender, body mass index and ASA class I/II between both groups with p-value >0.05.A significant difference was found regarding onset time of sensory and motor block between both groups (p=0.001). Mean sensory block duration in group A was more 425.18±17.82 minutes as compared to group B 254.43±20.44 minutes. Mean duration of motor block was also more in group A 418.65±20.84 minutes as compared to group B 226.15±12.52 minutes. Duration of analgesia was high in group A as compared to group B with p-value <0.05. Conclusion: In supraclavicular brachial plexus block 0.75% with 10mg of nalbuphine is particularly effective in sensory, motor, and analgesic periods in relation to ropivacaine alone. Keywords: Supraclavicular, Brachial plexus block, Ropivacaine, Nalbuphine, Duration of analagesia

scholarly journals Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block

2017 ◽  
Vol 5 (10) ◽  
pp. 4512 ◽  
Author(s):  
Usha K. Chaudhary ◽  
Amruth Danesh ◽  
Monika Mahajan ◽  
Sudarshan Kumar ◽  
Versha Verma ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Categorical Variables ◽  
Control Group ◽  
Double Blind Study ◽  
Continuous Variables ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

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.

scholarly journals A comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries

2018 ◽  
Vol 6 (7) ◽  
pp. 2407
Author(s):  
Fahad Khan ◽  
V. P. Singh
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Elective Surgery ◽  
Study Drug ◽  
Sensory Block ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries.Methods: Patients in the age group 18-58 years both male and female, having ASA 1 and ASA 2, scheduled for elective surgery of unilateral upper limb surgeries were included and randomly divided into three groups’ i.e. group RD, group RDI and group R and patients with chronic pain or taking any analgesics, ASA grade III and IV, bleeding disorders, history of brachial plexus injury, known allergy to the study drug, previous shoulder surgery, any psychiatric disorders, peripheral neuropathy, failed block, significant respiratory disease, hearing impairment, pregnant women, study were excluded.Results: Time to sensory onset in group RD was as compared to group RDI and group R was found statistically significant (p<0.001). Duration of sensory block (analgesia) in group RD, group RDI and Group R was also statistically significant (p<0.001). The level of sedation of Group RDI and Group RD had highly significant value till 30 mins (p<0.001).Conclusions: The central effects of dexmedetomidine also play some role in prolongation of sensory and motor block duration, as explained previously.

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