scholarly journals A Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine for Axillary Brachial Plexus Anaesthesia

1998 ◽  
Vol 26 (5) ◽  
pp. 515-520 ◽  
Author(s):  
D. P. McGlade ◽  
M. V. Kalpokas ◽  
P. H. Mooney ◽  
D. Chamley ◽  
A. H. Mark ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Median Duration ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Local Anaesthetics ◽  
Double Blind ◽  
Peripheral Nerve Stimulator ◽  
Upper Limb Surgery ◽  
Plexus Block

The purpose of this study was to compare the use of 0.5% ropivacaine with 0.5% bupivacaine for axillary brachial plexus anaesthesia. Sixty-six patients undergoing upper limb surgery were enrolled in a double-blind, randomized, multicentre trial. Five patients were subsequently excluded for various reasons. Of the remaining patients, 30 received 40 ml of 0.5%) ropivacaine and 31 received 40 ml of 0.5% bupivacaine. Brachial plexus block was performed by the axillary approach using a standardized technique with a peripheral nerve stimulator. Parameters investigated included the frequency, onset and duration of sensory and motor block, the quality of anaesthesia and the occurrence of any adverse events. The six principal nerves of the brachial plexus were studied individually. The frequency for achieving anaesthesia per nerve ranged from 70 to 90% in the ropivacaine group and 81 to 87% in the bupivacaine group. The median onset time for anaesthesia was 10 to 20 minutes with ropivacaine and 10 to 30 minutes with bupivacaine, and the median duration was 5.3 to 8.7h with ropivacaine and 6.9 to 20.3h with bupivacaine. Motor block was evaluated at the elbow, wrist and hand, and was completely achieved at a rate of 60 to 73% in the ropivacaine group and 55 to 71% in the bupivacaine group. The median duration of motor block was 6.5 to 7.5h with ropivacaine and 6.0 to 9.0h with bupivacaine. These parameters were not statistically different. The duration of partial motor block at the wrist (6.8 v 16.4h) and hand (6.7 v 12.3h) was significantly longer with bupivacaine. Ropivacaine 0.5% and bupivacaine 0.5%) appeared equally efficacious as long-acting local anaesthetics for axillary brachial plexus block.

scholarly journals A Comparison on Brachial Plexus Block Using Local Anaesthetic Agents With and Without Midazolam

2013 ◽  
Vol 3 (1) ◽  
pp. 11-13 ◽  
Author(s):  
Shailendra Nath Gautam ◽  
SK Bhatta ◽  
NR Sharma
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Gaba A ◽  
Medical College ◽  
Anaesthetic Agents ◽  
Plexus Block

Brachial plexus block provide surgical anesthesia and analgesia of upper extremity. Any adjuvant to brachial plexus block have less systemic side effect as well as reduce the total dose local anaesthetics. The midazolam acts on GABA-A receptors in peripheral nerve. The sensory and motor block was significantly faster in our study who received midazolam. This could be local anesthetic properties of midazolam and synergistic action with local anaesthetics. Total 100 patients between ages 10-77 years of either sex of ASA I-III, underwent upper arm surgery were given supraclavicular brachial block with and without midazolam. The onset and duration of sensory block in Gr I (XB) and Gr II (XBM) were significantly different. The onset time for sensory block was significantly prolong and duration of block significantly less compared to Gr II (P<0.05). The onset time for motor block was significantly less and duration significantly higher in Gr II (XBM) as compared to Gr I (XB). Midazolam 50ugm/kg in brachial plexus block speed sensory and motor block with post operative analgesia. Journal of Chitwan Medical College 2013; 3(1): 11-13 DOI: http://dx.doi.org/10.3126/jcmc.v3i1.8458

scholarly journals Effect of Addition of Dexamethasone to Local Anaesthetics in Supraclavicular Brachial Plexus Block

1970 ◽  
Vol 7 (1) ◽  
pp. 11-14 ◽  
Author(s):  
SM Islam ◽  
MHMD Hossain ◽  
AA Maruf
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Local Anaesthetics ◽  
Prolonged Duration ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Introduction: Many-a-time local anaesthesia appears as a very effective alternative of general one. Different additives have been used to prolong regional blockade. Objective: This prospective study designed to evaluate the effect of dexamethasone added to local anaesthetics on the onset and duration of supraclavicular brachial plexus block. Methods: Sixty adult patients undergoing various orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial plexus block were selected and divided into 2 groups of 30 each. In group-A patients received 35 ml of mixture of lignocaine 2%, bupivacaine 0.5% while in group-B patients received the same amount of local anaesthetics with dexamethasone (8 mg). The onset of sensory and motor block and duration of analgesia in two groups were compared and development of complications were observed. Result: The two groups were comparable in demographic data. The mean onset time of sensory block was 11.64±2.19 minutes in group A and 9.89±1.97 minutes in group B and difference was statistically significant (p<0.05). Onset of motor block was 13.32±0.98 minutes in group A and 11.09±1.28 minutes in group B and difference was statistically significant (p<0.05). There was markedly prolonged duration of analgesia in group-B, 11.87± 0.53 hours compared to group-A, 3.43±0.49 hours. The result was statistically highly significant (p<0.001). Both the groups had high success rate (>90%). The incidence of complication was low in both the groups. Conclusion: Addition of dexamethasone as an adjuvant to local anaesthetics in brachial plexus block results in significantly early onset and markedly prolonged duration of analgesia without any unwanted effects. Key words: Supraclavicular block; analgesia; local anaesthetics; dexamethasone DOI: http://dx.doi.org/10.3329/jafmc.v7i1.8619 JAFMC Bangladesh. Vol 7, No 1 (June) 2011; 11-14

Effect of Dexamethasone on The Duration of Analgesia for Supraclavicular Brachial Plexus Block

KYAMC Journal ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 199-203
Author(s):  
Md Rafiqul Islam ◽  
Laila Yesmin ◽  
Md Pervez Rahman ◽  
ABM Shafiul Anam Khan ◽  
Md Miraj Hossain ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block

Background: Brachial plexus block with Bupivacaine provides effective intraoperative anesthesia and analgesia. The use of dexamethasone along with local anesthetic has been shown to improve the duration of analgesia. Objective: To observe the effect of Dexamethasone on the duration of analgesia for Supraclavicular Brachial plexus block. Materials and Methods: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. patients were randomly divided into two groups, Group (BD) and B. Group B received 28 ml of 0.25% bupivacaine with 2 ml normal saline while Group BD received 28 ml of 0.25% bupivacain with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade. All the information was recorded in data collection sheet. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Results: There was no significant difference between groups in respect of demographic and American Society of Anaesthesiologist (ASA) status. Mean age was found to 34.7±8.53 years. In Group (BD) , 63.3% were ASA I and 36.6% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory anaesthesia can be made possible by addition of adjuvant to local anaesthetic in brachial plexus block (in Group-BD). onset of sensory block was faster in Group BD (8.17 ± 1.4 min) than Group B (9.12 ± 1.68 min). Similarly mean onset time of motor block in group A was 12.26 ± 3.96 min, and 11.58 ± 3.68 min in group B. Our study shows that duration of motor block was 408.68±26.96 min and 380.26 ± 24.11 min in group BD and Group B respectively. Conclusion: There was significantly prolonged duration of analgesia in addition of Dexamethasone without any unwanted effects. KYAMC Journal Vol. 11, No.-4, January 2021, Page 199-203

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. 

Block characteristics of Dexmedetomidine as an adjuvant to local anaesthetic in Infraclavicular brachial plexus block using peripheral nerve stimulator and ultrasound

2021 ◽  
Vol 23 (2) ◽  
pp. 40-46
Author(s):  
Ujma Shrestha ◽  
Sushila Lama Moktan ◽  
Sanjay Shrestha
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Peripheral Nerve Stimulator ◽  
Infraclavicular Brachial Plexus Block ◽  
Plexus Block

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.

scholarly journals Efficacy and Safety of Fentanyl as An Adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

2019 ◽  
Vol 17 (2) ◽  
pp. 31-35
Author(s):  
Sanjida Hasan ◽  
Ahmed Abu Nasar Chowdhury ◽  
Syeda Nafisa Khatoon ◽  
Md Harun OR Rashid ◽  
Md Rezaul Hoque Tipu ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Efficacy And Safety ◽  
College Hospital ◽  
Analgesic Effects ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Supraclavicular Block ◽  
Plexus Block

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block. Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml). Results: The mean onset of sensory & motor block was 10.49±0.75 min & 9.41±0.76 min in group-C and 7.60±3.711min & 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs. Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35

scholarly journals Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

2021 ◽  
Vol 10 (18) ◽  
pp. 4181
Author(s):  
Anil Ranganath ◽  
Tomas Hitka ◽  
Gabriella Iohom
Keyword(s):  
Brachial Plexus ◽  
Normal Saline ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Axillary Brachial Plexus Block ◽  
Group 2 ◽  
Plexus Block ◽  
Group 1

This study evaluated the effects of adding adjuvant clonidine to lidocaine with epinephrine on the characteristics of ultrasound-guided axillary brachial plexus block (ABPB) for upper extremity surgery. Twenty-four patients were randomised to receive an ultrasound guided ABPB with 20 mL of lidocaine 2% with 1:200,000 epinephrine plus 2 mL of either normal saline 0.9% (Group 1) or a mixture of clonidine 1 µg/kg and normal saline 0.9% (Group 2). The outcome measures that were recorded were the overall onset time and the duration of sensory and motor block. The median (IQR) overall onset time of sensory and motor block was significantly shorter in Group 2 vs. Group 1 (5 (5–7.5) min vs. 10 (8.8–12.5) min; p < 0.001) and (5 (2.5–7.5) min vs. 7.5 (6.3–7.5) min; p = 0.001), respectively. The median (IQR) overall duration of sensory and motor block was significantly longer in Group 2 vs. Group 1 (225 (200–231) min vs. 168 (148–190) min; p < 0.001) and (225 (208–231) min vs. 168(148–186) min; p < 0.001), respectively. In ultrasound-guided ABPB, the addition of clonidine to lidocaine with epinephrine resulted in shorter onset time and prolonged duration of sensory and motor block.

scholarly journals Efficacy and safety of ultrasound-guided brachial plexus blocks for upper limb surgery

2015 ◽  
Vol 10 (2) ◽  
pp. 164-171
Author(s):  
Raluca UNGUREANU ◽  
◽  
Liliana MIREA ◽  
Ioana GRINŢESCU ◽  
Dan TULBURE ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Block Success ◽  
Upper Limb Surgery ◽  
Locoregional Anesthesia ◽  
Plexus Block

Introduction. The use of ultrasound (US) for brachial plexus block has increased enthusiasm because the anesthesiologist can visualize anatomy, needle placement, and local anesthetic spread during locoregional anesthesia. The objectives of this prospective study was to evaluate the efficacy and the safety of ultrasound guided brachial plexus block comparative with traditional method of neurostimulation. Material and methods. In this randomized controlled clinical trial we included patients over 18 years old with upper limb surgery and who benefit of brachial plexus block (axillary, interscalenic or combined blocks). After monitoring and sedation, the patients randomly received ultrasound-guided (62 pts.) or neuro stimulation (63 pts.) brachial plexus block with ropivacaine 0.5%. We recorded data about: block success rate, sensitive and motor block onset time, block performance time, immediate and late complications events, patient’s satisfaction rate. The results were statistically analyzed, with significance assumed at p<0.05. Results. Block success rate with ultrasound guidance was very high (93.5% in US group and 84% in NS group). The patients of US group received less volume of local anesthetic (20.89 ± 3.9 ml vs. 43 ± 5.1 ml in NS group, p < 0.05). The performance time, needle punctures, sensory and motor onset time was significant reduced in US group. In the NS group we recorded 2 local anesthetic systemic toxicity (minor-moderate neurologic symptoms) with complete recovery and none in US group. We recorded less paresthesia during block performance and vascular puncture due to US guidance (p<0.05). Patient acceptance with locoregional anesthesia is good, even patients experience more discomfort during neurostimulation technique. Conclusions. The results of this study suggest that both techniques of execution of brachial plexus block are adequate for upper limb surgery but US guidance provides significant benefits for patients in terms of efficacy and safety.

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.

The Study of Effectiveness of Ropivacaine in Axillary Brachial Plexus Block for Forearm Surgery

2020 ◽  
Vol 22 (4) ◽  
pp. 248-253
Author(s):  
Sulav Acharya ◽  
GR Bajracharya ◽  
S Gauchan ◽  
N Dhakal
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Analgesic Effect ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Axillary Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block

Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects.Therefore this study was conducted to assess the block characteristics and side effects of 0.75% ropivacaine in axillary brachial plexus block for forearm surgeries. This interventional study was carried out in 30 patients of ASA physical status I or II, aged 18 to 60 yrs undergoing elective surgery u nder axillary brachial plexus block with 20 ml of 0.75 % Ropivacaine using ultrasound and nerve stimulator. The mean onset time of sensory block was 4.53 ± 1.18 minutes and duration of sensory block was 491.00 ± 57.45 minutes. The mean onset time of motor block was 9.17 ± 1.39 minutes and duration of motor block was 452.50 ± 52.34 minutes. The mean time for rescue analgesia or total analgesic effect was 569.47 ± 88.46 minutes. No patients developed any side effects. The result of this study concluded that Ropivacaine is a safe drug providing longer duration of sensory analgesic effect and early recovery of motor function with good operating conditions for forearm surgeries under brachial blexus block.

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