Tramadol as an adjunct to local anaesthetics in brachial plexus block: a meta-analysis

Introduction: Dexmedetomidine has been frequently used in regional anaesthesia to improve the quality of blocks. Addition of dexmedetomidine to local anaesthetics has been shown to hasten the onset of both sensory and motor blocks and also prolong the duration of analgesia. The objective of this prospective comparative study was to assess the change in characteristics of infraclavicular brachial plexus block after adding Inj. Dexmedetomidine to 2% Lignocaine with Adrenaline. Methods: Sixty-six patients, scheduled for upper limb surgeries under ultrasound guided infraclavicular brachial plexus block were randomly allocated to two groups. Group LS received Inj. Lignocaine 2% with Adrenaline, 7mg/kg diluted to 30 ml with saline and Group LD received Inj. Dexmedetomidine 0.75 mcg/kg in addition to Inj. Lignocaine 2% with Adrenaline, 7mg/kg again diluted to a total volume of 30 ml. The parameters studied were: onset of sensory and motor blocks and duration of analgesia. Results: Sixty patients completed the study. The demographic variables and motor block were similar between both groups. The mean time to onset of sensory block was significantly faster in Group LD compared to Group LS (9.80±4.85 min vs 12.30±3.97 min, p=0.033). The duration of analgesia was also found to be prolonged in Group LD compared to Group LS (286.73±55.38 min vs 226.53±41.19 min, p < 0.001). Conclusion: Addition of 0.75 mcg/kg of Dexmedetomidine to 2% Lignocaine with Adrenaline hastens the onset of sensory block and prolongs the duration of analgesia in ultrasound guided and peripheral nerve stimulator guided infraclavicular block.

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Peer review report 1 on “Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials”

International Journal of Surgery ◽

10.1016/j.ijsu.2017.08.004 ◽

2017 ◽

Vol 37 ◽

pp. 471

Author(s):

Korhan Ozkan

Keyword(s):

Brachial Plexus ◽

Peer Review ◽

Brachial Plexus Block ◽

Meta Analysis ◽

Shoulder Surgery ◽

Interscalene Brachial Plexus Block ◽

Clinical Control ◽

Supraclavicular Block ◽

Plexus Block

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Dexamethasone added to Bupivacaine prolongs the duration of analgesia for supraclavicular brachial plexus block

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v17i2.35887 ◽

2018 ◽

Vol 17 (2) ◽

pp. 296-301

Author(s):

Naimul Hoq ◽

Abdullah Al Maruf

Keyword(s):

Brachial Plexus ◽

Upper Extremity ◽

Brachial Plexus Block ◽

Medical Science ◽

Local Anaesthetics ◽

Distilled Water ◽

Dexamethasone Group ◽

Prolonged Duration ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

Background: Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia. Numerous adjuncts have been added to enhance the efficacy of the block. Steroids have anti-inflammatory as well as analgesic effects.Objectives: This study has been undertaken with a view to find out the efficacy of dexamethasone to increase the duration of analgesia when used as an adjuvant to bupivacaine in supraclavicular brachial plexus block in upper extremity surgery.Methods: Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block were randomly divided into two equal groups of 30 each; Bupivacaine group-‘’A’’ received 0.5% bupivacaine 2 mg/kg with distilled water 15 ml and Dexamethasone group-‘’B’’ received 0.5% bupivacaine 2 mg/kg with dexamethasone (0.2mg/kg) with distilled water 15 ml. The duration of analgesia in the two groups were compared.Results: There was markedly prolonged duration of analgesia in dexamethasone group. The mean duration of analgesia in bupivacaine group was 455 ± 17.09 minutes, whereas in dexamethasone group it was 864.50 ± 25.19 minutes. The results were statistically highly significant.Conclusion: Dexamethasone when added to bupivacaine in brachial plexus block it results significantly prolonged duration of post-operative analgesia, which was significantly higher in comparison to bupivacaine when it is used alone.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.296-301

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The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil

Anaesthesia ◽

10.1111/j.1365-2044.1997.174-az0311.x ◽

1997 ◽

Vol 52 (9) ◽

pp. 858-862 ◽

Cited By ~ 68

Author(s):

J. E. Bazin ◽

C. Massoni ◽

P. Bruelle ◽

V. Fenies ◽

D. Groslier ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Local Anaesthetics ◽

Plexus Block

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Perineural Dexamethasone Added to Local Anesthesia for Brachial Plexus Block Improves Pain but Delays Block Onset and Motor Blockade Recovery

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.1 ◽

2015 ◽

Vol 18;1 (1;1) ◽

pp. 1-14

Author(s):

Kenneth D. Candido

Keyword(s):

Postoperative Pain ◽

Brachial Plexus ◽

Postoperative Analgesia ◽

Motor Block ◽

Brachial Plexus Block ◽

Meta Analysis ◽

Pain Scores ◽

Central Registry ◽

Plexus Block ◽

Higher Doses

Background: Multiple studies have shown that perineural dexamethasone improves postoperative analgesia. However, some studies have shown minimal benefit, and have raised concerns regarding adverse physio-chemical effects of perineural dexamethasone. Furthermore, there is a paucity of studies wherein control (IV) dexamethasone was considered. Objective: The purpose of this meta-analysis was to evaluate the effectiveness of different concentrations of perineural dexamethasone injection on postoperative analgesia, as well as complications from its use for brachial plexus blocks. Methods: A systematic literature search was conducted using the Cochrane Central Registry of Controlled Trials, PubMed, and Scopus. Trials comparing control and local dexamethasonetreated groups, and those which reported duration of analgesia and/or pain scores/opioid consumptions were selected. Meta-analysis was performed using the Review Manager (RevMan) software 5.1. Results: Fourteen studies consisting of a total of 1,022 patients were included. Perineural dexamethasone significantly prolonged the duration of postoperative analgesia in patients receiving both low-dose (4 – 5 mg) [SMD 2.41 (95% CI: 1.47, 3.35 P = 0<0.00001) I2 = 82%], and higher-doses (8 – 10 mg) [SMD 4.46 (95% CI 3.54, 5.38 P < 0.00001) I2 = 94%]. However, the duration of motor block was also prolonged [SMD 2.52 (95% CI: 1.06, 3.98 P = 0.0007) I2 = 97%] and dexamethasone delayed latency of onset of sensory [SMD -0.49 (95% CI: -0.89, -0.09 P = 0.02) I2 = 76%] and motor [SMD -0.56 (95% CI: -1.13, 0.00 P = 0.05) I2 = 87%] blocks. Postoperative pain scores were improved at both 24 hours [SMD -1.46 (95% CI: -2.43, -0.50 P = 0.003) I2 = 95%] and 48 hours [SMD -1.20 (95% CI: -2.26, -0.13 P = 0.03) I2 = 95%] in dexamethasone-treated groups, whereas opioid consumption was reduced only at 48 hours [SMD -2.97 (95% CI: -4.17, -1.76 P < 0.00001) I2 = 88%]. Complications were comparable between control and dexamethasone-adjuvant groups, except for the excessively prolonged nerve block that was observed predominantly in the dexamethasone-adjuvant group. Limitations: The limitations include different definitions used for the measurements of certain parameters such as the duration of analgesia and duration of motor block, number of studies assessing certain parameters having high heterogeneity, and varying types of local anesthetics used in various studies. Conclusions: Perineural dexamethasone addition to local anesthetic solutions significantly improved postoperative pain in brachial plexus block without increasing complications. However, perineural adjuvant dexamethasone delayed the onset of sensory and motor block, and prolonged the duration of motor block. Smaller doses of dexamethasone (4 – 5 mg) were as effective as higher doses (8 – 10 mg). Key words: Dexamethasone, perineural, brachial plexus block, postoperative pain, metaanalysis, systematic review

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Hoarseness of Voice following Left Supraclavicular Brachial Plexus Block: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.7087 ◽

2021 ◽

Vol 59 (241) ◽

pp. 925-928

Author(s):

Subin Shrestha ◽

Sadikshya Regmi ◽

Gopendra Deo ◽

Indra Narayan Shrestha

Keyword(s):

Brachial Plexus ◽

Recurrent Laryngeal Nerve ◽

Brachial Plexus Block ◽

Rare Complication ◽

Local Anaesthetics ◽

Laryngeal Nerve ◽

Ultrasound Guided ◽

Supraclavicular Brachial Plexus Block ◽

Supraclavicular Block ◽

Plexus Block

Supraclavicular brachial plexus block is extensively used for primary regional anaesthesia as well as postoperative analgesia for the surgical procedures of the upper limb. The evidence for the use of ultrasound in supraclavicular brachial plexus is growing day by day as it has the advantage of allowing real time visualisation of the plexus, pleura and vessels along with the needle and local anaesthetics spread. Despite this, complications can even arise with ultrasound guided supraclavicular brachial plexus block. Hoarseness of voice due to recurrent laryngeal nerve block is a rare complication of supraclavicular brachial plexus block. There are few reported cases of hoarseness of voice following the right supraclavicular block. There is only one reported case of hoarseness of voice following the left supraclavicular block. Here, we report a case of a 16-year-old boy who developed hoarseness of voice due to left recurrent laryngeal nerve following ultrasound guided left supraclavicular brachialplexus block.

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

QJM ◽

10.1093/qjmed/hcaa039.005 ◽

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 < 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.

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