The effect of adding Magnesium sulfate to Bupivcaine in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Samah Medhat Eid ◽  
Sahar Kamal Aboul ella ◽  
Hala Salah El-Din El-ozairy ◽  
Thabet Aziz Naser
Keyword(s):  
Brachial Plexus ◽  
Magnesium Sulfate ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Control Group ◽  
P Value ◽  
Age Group ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Abstract Background Brachial plexus is a bundle of nerves that arises from the neck crossing through the axilla to supply the whole upper limb with motor and sensory supply. The aim in upper limb surgeries is to block this plexus using local anesthetics. Objective To study the effect of magnesium sulfate as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Patients and Methods In our study 82 adult patients (age group 18-60, ASA I-II) were randomly and evenly divided into two equal groups (41 patients each), control group received only bupivacine 0.5 % and magnesium group received 2.5ml of 10% of magnesium in addition to bupivacine 0.5%. Patients were in semisitting position 45° the block was introduced US guided. Results Our study showed that addition of 250 mg of magnesium to bupivacine slightly delayed the onset time of both sensory and motor block (p value >0.05) which was non significant. Conclusion The addition of 250 mg magnesium sulfate to bupivacaine 0.5 % solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade, the duration of postoperative analgesia and reduces the requirement of rescue analgesic without any detected side effects.

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 ROPIVACAINE VERSUS ROPIVACAINE WITH DEXMEDETOMIDINE AS AN ADJUVANT IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

2021 ◽  
pp. 138-142
Author(s):  
Deba Gopal Pathak ◽  
Dipanjali Nath
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Blockade ◽  
Suitable Alternative ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

BACKGROUND : Supraclavicular approach to brachial plexus block is a versatile and reliable regional anesthesia technique and a suitable alternative to general anesthesia for upper limb surgical procedures. Ropivacaine , a long acting local anesthetic, with less tendency for neurotoxicity and cardiotoxicity is a great local anesthetic for the procedure. Use of adjuvant Dexmedetomidine , a potent alpha 2 adrenoreceptor agonist improves the quality of anesthesia as well as intra-operative and post-operative analgesia while maintaining haemodynamic stability, arousable sedation and mild respiratory depression. MATERIALS AND METHODS: Eighty patients aged between 18 and 60 years with ASA grade I or II posted for elective upper limb surgeries were included in the study and were randomly divided into 2 groups with forty patients in each. Group A received 0.5% ropivacaine (31 mL) and Group B received 0.5% ropivacaine + dexmedetomidine 1microgram/kg (31mL). Both groups were compared for onset time and duration of sensory blockade, onset time and duration of motor blockade , total duration of analgesia and associated side effects. CONCLUSION : Dexmedetomidine as an adjuvant to ropivacaine in the supraclavicular brachial plexus block for upper limb surgeries , significantly shortens the onset time and prolongs the duration of sensory and motor blocks, with longer duration of post-operative analgesia , with associated significant sedation and a few manageable side effects like bradycardia and hypotension.

scholarly journals Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Y Ibrahim ◽  
H A Labib ◽  
H F A Toulan ◽  
E A Deabes
Keyword(s):  
Brachial Plexus ◽  
Magnesium Sulfate ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
University Hospital ◽  
Control Group ◽  
Significant Difference ◽  
Plexus Block

Abstract Background In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia. Aim of the Work is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study. Results Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P &lt; 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups. Conclusion Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.

scholarly journals A Comparative Study Between Two Different Doses of Dexmedetomidine Combined with Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

2018 ◽  
Vol 14 (3) ◽  
pp. 127-131
Author(s):  
Jeevan Singh ◽  
Samir Shakya ◽  
Anuranjan Ghimire ◽  
Sanjay Saha ◽  
Parikshit Bikram Singh
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
P Value ◽  
Double Blind ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Different Doses

Background: Though, various studies have been conducted to show the efficacy of            dexmedetomidine as an adjuvant to brachial plexus block, there is no clear consensus for its optimal dose. We compared 2 different doses of dexmedetomidine (1mcg/kg Vs 2mcg/kg) with ropivaciane in USG guided brachial plexus block for the quality of anesthesia and analgesia. Materials and Methods: Fifty patients (18-50years, 50-60kgs), ASA PS I and II undergoing surgery of upper limb were enrolled in this prospective, double blind, randomized control trial. Group Rd received 19ml of 0.5% Ropivaciane with 1mcg/kg  of dexmedetomidine (total 20ml), and Group RD received 19ml of 0.5% Ropivacaine with 2mcg/kg of dexmedetomidine (total 20ml). Onset and duration of sensory and motor block, duration of analgesia, sedation score, hemodyanamic changes were compared. We also monitored for various un towards effects. Results: The onset time of sensory and motor block (9.36±1.114 mins and 14.40 ± 1.528 mins in group Rd vs 8.32 ±0.945 mins and 12.40 ± 1.21 mins in group RD) were not significantly different between two groups (p-value > 0.05).The duration of sensory and motor block (596.20 ± 76.859 mins and 541.20±81.564 mins in group Rd vs 730.80 + 65.187 mins and 659.80±93.607 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). The duration of analgesia (626.00±70.475 mins in group Rd vs 754.00±60.139 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). Hemodynamic parameters were also comparable between two groups (p-value >0.05) but 3 patients in RD group (2mcg/kg) developed bradycardia and required treatment with atropine whereas in Rd group (1mcg/kg) none developed bradycardia. Conclusions: There is no significant difference in the onset and duration of block between the two groups. However, higher dose of    dexmedetomidine is associated bradycardia. Hence, in comparision with 2mcg/kg, 1mcg/kg of   dexmedetomidine is better adjuvant to 0.5% ropivaciane in terms of safety and effectiveness.Keywords: dexmedetomidine; ropivacaine; supraclavicular brachial plexus block. 

scholarly journals Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

2019 ◽  
Vol 2 (1) ◽  
pp. 48-54
Author(s):  
Sabin Gauchan ◽  
Samyukta Acharya ◽  
Dikshya Karki
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
P Value ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block ◽  
Group D

Introduction: The objective of this study was to evaluate the effect of 50μg dexmedetomidine on the onset and duration of block and duration of analgesia when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block. Methods: Eighty patients of ASA physical status I and II undergoing elective upper limb surgery under ultrasound guided supraclavicular brachial plexus block were randomly divided into two groups: Group D and Group B. Group D (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml (50 μg) dexmedetomidine. Group B (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml normal saline. Onset time of sensory and motor block, duration of sensory and motor block and duration of analgesia was recorded. Results: Onset time of sensory block (10.55±4.84 min in Group D vs 12.50 ±5.20 min in Group B) and motor block (15.85±5.9min in Group D vs 18.35±5.6min in Group B) though earlier in Group D as compared to Group B was not statistically significant (p value =.087 for sensory block and p value=.058 for motor block). The duration of sensory block (772.20 ±167.84 min in Group D vs 398.38 ±129.839min in Group B) and motor block (725.63±140.964min in Group D vs 361.88±128.764 min in Group B) was statistically significantly prolonged in Group D (p value= .000 for sensory and p value =.000 for motor block). The Duration of analgesia (845.93±184.545min in Group D vs 430.04±121.307 min in Group B) was also statistically significantly prolonged in group D (p value= .000). Conclusions: Dexmedetomidine (50 μg) as an adjuvant to 0.5% bupivacaine solution in ultrasound guided supraclavicular brachial plexus block prolongs the duration (sensory and motor) of block as well as the duration of analgesia with no effect on the onset time of block. Keywords: brachial plexus block; bupivacaine; dexmedetomidine. Correspondance: Dr.

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

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