scholarly journals Comparative study of ropivacaine alone versus ropivacaine with dexamethasone in supraclavicular brachial plexus block

2017 ◽  
Vol 4 (12) ◽  
pp. 3879 ◽  
Author(s):  
Sampathi Shiva Krishna ◽  
G. Praveen Chandra ◽  
C. Krishna Chaithanya
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Statistical Difference ◽  
Brachial Plexus Block ◽  
Total Duration ◽  
Duration Of Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Very High

Background: Brachial plexus block is often used either as an adjuvant to general anesthesia (GA) or as a sole anesthesia modality. Supraclavicular brachial plexus block is preferred for its rapid onset, reliable anesthesia and as a safe technique for any surgery in the upper extremity that does not involve the shoulder. We have attempted to undertake this study to compare the haemodynamic, sensory and motor effects of the anaesthetic effect of Ropivacaine alone and Ropivacaine along with Dexamethasone in Supraclavicular Brachial Block in upper limb surgery.Methods: The total duration of surgery was also comparable in both groups. The onset of the sensory and the motor block in bother the groups were similar to each other with no statistical difference, but there was a very high significance in the duration of both sensory and motor block within both the groups.Results: The total duration of surgery was also comparable in both groups. The onset of the sensory and the motor block in bother the groups were similar to each other with no statistical difference, but there was a very high significance in the duration of both sensory and motor block within both the groups.Conclusions: Dexamethasone added to ropivacaine in supraclavicular brachial block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor blocks without producing sedation in patients.

scholarly journals Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries

2017 ◽  
Vol 5 (5) ◽  
pp. 1943 ◽  
Author(s):  
Kartheek Hanumansetty ◽  
Hemalatha S. ◽  
Gurudatt C. L.
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Upper Limb ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Peak Effect ◽  
Motor Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: The supraclavicular brachial plexus block has proven to be an important, safer and effective alternative to general anaesthesia in surgeries of upper extremity. Primary aim is to study the effect of addition of dexamethasone to levobupivacaine on postoperative analgesia and secondary objectives are to study onset, peak effect and duration of sensory and motor block in brachial plexus blockade in adult patients posted for upper limb surgeriesMethods: This prospective randomized clinical study was conducted on 60 patients of age 18 to 60 years posted for upper limb surgeries. They were randomly allocated into two groups of 30. In Control group LS (n=30) received Inj. Levobupivacaine 30ml and Inj. Normal saline 2ml. In Study group LD (n=30) received Inj. Levobupivacaine 30ml and Inj. Dexamethasone 2ml (8mg).Results: Both the groups were demographically comparable. Onset of sensory block and motor block in group LD and in group LS were similar (p>0.05). Mean duration of sensory and motor block in group LD was higher than in group LS (<0.001). Duration of postoperative analgesia was 21.20±3.23 hours in group LD and 10.24±1.57 hours in group LS (p<0.001).Conclusions: Dexamethasone added to levobupivacaine for brachial plexus block prolonged the duration of sensory, motor blockade and postoperative analgesia but did not alter the onset time, peak effect time of sensory and motor blockade.

scholarly journals A CLINICAL COMPARISON OF 0.75% ISOBARIC ROPIVACAINE WITH 0.5% ISOBARIC BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

2020 ◽  
pp. 43-46
Author(s):  
Kalyan Sarma ◽  
Bandana Mahanta ◽  
Prabir Pranjal Das
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Motor Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Group B ◽  
Plexus Block

Background: Regional anaesthesia and analgesia, has the potential to provide excellent operating conditions along with better and prolonged post-operative with pain relief with fewer side effects. As a result, it is becoming increasingly popular for ambulatory anaesthesia and for day care patients.. Among the commonly used local anaesthetics, lignocaine and bupivacaine, bupivacaine has significant cardiovascular and central nervous system toxicity. In addition, bupivacaine also has lesser differentiation between sensory and motor blockade post-operatively. Ropivacaine and levobupivacaine were developed to avoid the bupivacaine related toxicities. The clinical safety profile of ropivacaine seems to be more favourable than that of levobupivacaine. With this background the following study was conducted to evaluate the efficacy of ropivacaine 0.75% for brachial plexus block in upper limb surgeries and its clinical comparison with bupivacaine 0.5%. Aims and Objectives: To assess the efficacy and toxicity of ropivacaine 0.75% and bupivacaine 0.5% as potential agents for brachial plexus block for surgeries of the upper limb around and below the elbow. Settings and Design: prospective, comparative, randomized, single blinded clinical trial. Materials and Methods: After institutional ethical committee approval, 100 patients physical status ASA I & II, of either sex, between 18-60 years, weighing between 40-60 kgs posted for upper limb surgeries around the elbow, forearm and hand were divide into two groups of 50 patients each. Group R (Ropivacaine group) received 0.75% isobaric ropivacaine 30 ml in supraclavicular brachial plexus block. Group B (Bupivacaine group) received 0.5% isobaric bupivacaine 30 ml in supraclavicular brachial plexus block by using peripheral nerve stimulator. Vitals, sensory, motor and analgesia score at pre-defined intervals intra-operatively were noted. Onset of analgesia, sensory & motor blockade, total duration of post-operative pain relief (VAS ≥ 5) and time of demand of first rescue analgesic were also noted along with any intra-operative complications, if any. Statistical Analysis: All the results were expressed as Mean ± SD. Statistical analysis was performed using Unpaired Student’s t-Test. Statistical significance was considered with a p value of ≤ 0.05. Results: Demographic profile and duration of surgery were comparable among the two groups. The mean time of onset of sensory block, onset of motor block and onset of analgesia were significant (p<0.05) in group R as compared to group B. The mean duration of sensory block and duration of post-operative analgesia were comparable between the two groups. However, the mean duration of motor block was significantly lower (p<0.05) in group R as compared to group B. the baseline hemodynamic variables and requirement of first analgesic dose and other adverse events were equivalent in both the group. Conclusion: Ropivacaine when compared with Bupivacaine, has faster onset of analgesia, sensory & motor blockade, significantly lesser duration of motor blockade. Ropivacaine also provides satisfactory post-operative analgesia with a stable hemodynamic profile similar to Bupivacaine with no undue adverse effects.

SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERIES: ULTRASOUND-GUIDED VERSUS NERVE STIMULATORTECHNIQUE

2017 ◽  
pp. 104-108
Author(s):  
Van Tri Nguyen ◽  
Van Minh Nguyen
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Ultrasound Guided ◽  
Group I ◽  
Supraclavicular Brachial Plexus Block ◽  
Group Ii ◽  
Plexus Block

Objective: To compare the onset and duration ofsensory and motor blockade,success and complications rate of these two techniques. Subjects and methods: One hundred and twenty patients undergoing upper limb surgeries at Hue Central Hospital from May 2016 to May 2017 were divided into two groups. Group I underwentultrasound-guided supraclavicular brachial plexus block, group II with nerve stimulator. Each group received 25ml levobupivacaine 0.5% and 1/200000 adrenalin. Results:The procedure time (9.82 ± 4.55 vs 14.73 ± 4.73 min), the onset of sensory (6.15 ± 1.60 vs 9.92 ± 2.88 min) and motor block (7.95 ± 1.05 vs 12.63 ± 2.15 min) in group I were significant shorter than in Group II (p < 0.05). The duration of sensory and motor block, (481.38 ± 116.66 vs 319.22 ± 143.14 min and 412.97 ± 107.32 vs 205.88 ± 48.96 min, respectively) were significant longer in group I than in Group II (p < 0.05). The success rate (98.3% vs 90%) and complication incidence (1.7% vs 8.4%) were comparable between two groups. Conclusion: Ultrasound guidance for supraclavicular brachial plexus blockade provided faster onset, longer duration of sensory and motor block, higher success rate with fewer complications in comparison withnerve stimulator technique Key words: brachial plexus block, ultrasound-guided

scholarly journals A PROSPECTIVE, RANDOMIZED, DOUBLE BLINDED, CONTROLLED STUDY TO EVALUATE THE EFFICACY OF DEXMEDETOMIDINE 50µg AND DEXAMETHASONE 8mg AS AN ADJUVANT TO ROPIVACAINE 0.5% FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN ELECTIVE UPPER LIMB SURGERIES.

2020 ◽  
pp. 63-65
Author(s):  
Kavya Madhyastha ◽  
Shashikala T K
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Total Duration ◽  
Saline Group ◽  
Primary Objective ◽  
Controlled Study ◽  
Supraclavicular Brachial Plexus Block ◽  
Double Blinded ◽  
Plexus Block

BACKGROUND: Brachial Plexus Blocks are the popular choice of anaesthesia technique as a part of day care surgeries for upper limb. In this study, efficacy of non opioid adjuvants Dexamethasone and Dexmedetomidine has been evaluated. MATERIALS AND METHODS: 90 ASA class I and II patients undergoing elective upper limb surgeries were randomly divided into three groups of 30 each. Group C received 0.5% Ropivacaine 28ml with 2ml normal saline, Group DX received 0.5% Ropivacaine 28ml with 8mg Dexamethasone and Group DM received 0.5% Ropivacaine 28ml with Dexmedetomidine 50µg. The primary objective was to know the sensory and motor block onset, total sensory and motor block duration, total duration of analgesia. Secondary parameters were mean arterial pressure, peripheral saturation and sedation score. Statistical methods were carried out through SPSS for Windows(version 16.0) RESULTS: The sensory and motor block onset was earlier in Group DM compared to Group C and Group DX, while it was later in Group DX compared to Group C. The mean TSBD, TMBD and TDA was longer in Group DX(746.66min, 677.83min, 800.16min) compared to Group C (361.33min, 303.66min, 411.16min)and Group DM(686.33min, 593.5 min, 701.83min). There was no significant change in MAP, SpO2 and sedation scores.

scholarly journals A prospective randomized clinical study to compare the efficacy of 0.25% bupivacaine with clonidine and 0.25% levobupivacaine with clonidine in supraclavicular brachial plexus block for upper limb surgeries

2021 ◽  
Vol 8 (4) ◽  
pp. 543-550
Author(s):  
Abhishek R ◽  
Arun Aravind ◽  
Shankaranarayana P
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Racemic Mixture ◽  
Hemodynamic Parameters ◽  
Randomized Clinical Study ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

:Bupivacaine is an amide local anesthetic, available as a racemic mixture of Dextro and Levorotatory Isomers. Due to its rapid onset and longer duration of anesthesia, It is routinely preferred in various regional anesthetic techniques. However, it is associated with serious cardiovascular and neurological toxicity. Its pure S- enantiomer, Levobupivacaine having similar pharmacological profile is known to have lesser cardiovascular and CNS toxicity. Combining adjuvants like clonidine, a centrally acting partial alpha-2-adrenergic agonist to improve quality of anesthesia is common practice. Hence, the aim of our study is to compare efficacy and safety of 0.25% Levobupivacaine and 0.25% Bupivacaine when combined with clonidine in supraclavicular brachial plexus block for upper limb surgeries.Eighty patients aged between 18 to 60 years with ASA physical status I-II, scheduled for elective upper limb surgeries under were randomized into two groups. Peripheral nerve stimulator guided Supraclavicular brachial plexus block was administered. Group BC received 30ml of 0.25% Bupivacaine plus 1µg/kg Clonidine and Group LC 30ml of 0.25% Levobupivacaine plus 1µg/kg Clonidine. The time of onset of sensory and motor block, duration of sensory and motor block, perioperative hemodynamic parameters, postoperative pain for 24hours and adverse effects were studies.Group LC had faster onset of sensory block (p= 0.014) as well as faster onset of motor block (p= 0.012) compared to group BC. However, durations of sensory block and motor block were statistically not significant in both the groups (p&#62;0.05). Perioperative hemodynamic parameters and assessment of pain during 24 hours of post operative period were comparable and statistically not significant.1mcg/kg of clonidine used as an adjuvant to 30ml of 0.25% Levobupivacaine produces faster onset of sensory and motor block compared to 0.25% Bupivacaine in supraclavicular brachial plexus block. However, similar anesthetic efficacy in terms of duration of sensory and motor block, hemodynamics and postoperative analgesia were observed.

scholarly journals A prospective randomised study of adjuvants for supraclavicular brachial plexus block: Clonidine vs Dexamethasone

2021 ◽  
Vol 8 (4) ◽  
pp. 511-514
Author(s):  
Akanksha Aggarwal ◽  
Nimit Gandhi
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anaesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Group 2 ◽  
Plexus Block ◽  
Group 1

 Supraclavicular brachial plexus block is among foremost technique of regional anaesthesia administered during upper-limb surgery. Different adjuvants have been used with varied results for prolonging the sensory and motor blockade. Dexamethasone and Clonidine have been established as suitable adjuvants for blocks. Adding adjuvants to local anaesthetic drugs in nerve blocks has many benefits. We studied performance of dexamethasone or clonidine as additives to local anaesthetic in subclavian perivascular block as a part of upper limb surgery. Aim was to ascertain which of them is a better adjuvant. Study population was randomized to 2 groups of 50 patients each. Group 1 was given 5 ml of 2% lignocaine and 15 ml 0.5% bupivacaine with 8mg dexamethasone. Group 2 received 5ml 2% lignocaine and 15 ml 0.5% bupivacaine with 0.150 mg clonidine. Time to establishment of sensory & motor block, duration of analgesia and any adverse effects were observed. Statistical analysis was done with SPSS 13.0. Quantitative variables were assessed using student t test. Qualitative variables were analysed using Chi square test. P value &#60; 0.05 was defined as significant. Onset of sensory blockade was at 7.23+4.24 in group 1 and 8.36+2.68 minutes in Group 2. Average time to motor block was at 8.48+3.22 minutes in Group 1 and 9.58+3.71 minutes in Group 2. Analgesia’s duration in Group 1 and Group 2 was 998.2+338.5 and 879.3+284.5 minutes respectively. No major adverse events were seen in either group. Performance of dexamethasone was similar to clonidine as adjunct to local anaesthetic in subclavian perivascular approach of brachial plexus block. However, it has faster sensory and motor blockade’s onset. Analgesia’s duration observed was found to be longer, though the difference was statistically insignificant.

scholarly journals EVALUATION OF ANALGESIC EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT CO-ADMINISTERED WITH 0.75% ROPIVACAINE BY SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERY

2020 ◽  
pp. 25-27
Author(s):  
Bimal Kumar Hajra ◽  
Stuti Chakraborty ◽  
Keka Pandey ◽  
Debarshi Jana
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Analgesic Efficacy ◽  
Cost Effective ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

INTRODUCTION Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. OBJECTIVES To compare time of onset and duration of sensory and motor block between two groups. To compare peri-operative and post-operative analgesia between two groups MATERIAL AND METHOD Orthopaedic operation theatre, post-anaesthesia care unit, orthopaedic post- operative ward of Nil Ratan Sircar Medical College and Hospital. All the ASA physical status I and II patients of either sex, age between 18-60 years undergoing upper limb orthopaedic surgery under supraclavicular brachial plexus block. CONCLUSION Addition of Dexmedetomidine to ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia and motor block in patients undergoing upper limb surgeries and is a remarkably safe and cost effective method of providing post-operative analgesia.

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 Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study

2017 ◽  
Vol 5 (5) ◽  
pp. 2139 ◽  
Author(s):  
Shaheena Parveen ◽  
Masrat Jan ◽  
Arshi Taj ◽  
Arif A. Bhat
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Group I ◽  
Supraclavicular Brachial Plexus Block ◽  
Group Ii ◽  
Plexus Block

Background: Supraclavicular brachial plexus block is a good alternative to general anesthesia in surgeries of elbow, forearm, wrist and hand. The aim of this study was to assess the effect of dexamethasone as an adjuvant with bupivacaine in supraclavicular brachial plexus block in upper limb surgeries.Methods: This study was carried out on 60 adult patients of both sexes planned for upper limb surgery during the period from May 2015 to Jan 2016 after approval by the institutional Ethical Committee. Inclusion criteria were American Society of Anesthesiologists physical Status I-II and age between 18 and 50 years. Patients were randomly allocated to two groups of 30 patients each [group I (bupivacaine alone) and group II (bupivacaine + dexamethasone)]. Group I received 30ml of 0.5% bupivacaine with 2ml normal saline while group II received 30ml of 0.5% bupivacaine with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. Statistical analysis was performed with SPSS for Windows (SPSS Inc., Chicago, IL, USA), version 16.0. For analysis of demographic data and comparison of groups, χ2, unpaired Student's t-test and Mann-Whitney U-test were performed. Power of significance p-value of <0.05 was considered to be statistically significant. We evaluated onset, quality and duration of sensory and motor block along with side effects if any.Results: The mean onset of sensory and motor block in Group I and II was statistically insignificant. The duration of motor and sensory block was significantly prolonged in Group II than in Group I. There were no statistically and clinically significant differences in respiratory and hemodynamic parameters.Conclusions: We conclude that dexamethasone as an adjuvant in supraclavicular brachial plexus block prolongs the duration of motor and sensory block with insignificant side effects.

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