scholarly journals A Prospective Randomised Controlled Double-Blinded Comparative Study of Plain Bupivacaine versus Bupivacaine and Dexamethasone for Supraclavicular Brachial Plexus Block, Government General Hospital, Nizamabad

2021 ◽  
Vol 8 (16) ◽  
pp. 1003-1008
Author(s):  
Chintala Kishan ◽  
Ravi Kiran Kumar G ◽  
Inugurthy Sridhar ◽  
Kiran Madhala
Keyword(s):  
Blood Pressure ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Single Shot ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
The Mean ◽  
Double Blinded ◽  
Plexus Block

BACKGROUND Dexamethasone (DES) is a very potent anti-inflammatory and analgesic glucocorticoid with very strong activity. The current study is randomised to determine the onset time, duration, and analgesic potency of bupivacaine (BUC) 0.5 percent, relative to BUC 0.5 percent and DES 8 mg by supraclavicular approach for brachial plexus block. METHODS In patients posted for upper limb surgery under a supraclavicular block, a prospective, randomised, double-blinded study was conducted. 60 Class I and II American Society of Anesthesiologists (ASA) patients were randomly divided into two classes. Group A received 0.5 percent of 30 ml BUS and group B received 0.5 percent of 28 ml BUS and 8 mg of 2 ml DES combined. For a single shot blockade of the supraclavicular brachial plexus, 30 ml of a solution was required. RESULTS The mean age of patients who received BUS was 36.9 ± 10.4 years and those who received BUS + DES was 34.7 ± 7.1 years (P = 0.328), there was no statistically significant difference between the mean ages of two groups (P > 0.05). The mean time of onset of sensory block in the BUS group was 8.6 ± 1.2 minutes and 5.6 ± 0.7 minutes in the BUS + DES group. There was a statistically significant difference between the onset of motor block in minutes among BUS and BUS + DES groups, there was a statistically significant difference between the mean ages of the two groups (P < 0.001). There was no statistically meaningful difference between the BUS and BUS + DES classes at various time intervals in the mean heart rate, difference in systolic blood pressure and diastolic blood pressure, and oxygen saturation. CONCLUSIONS The start of sensory and motor blockade also prolongs the length of DES 8 mg to BUS 0.5 percent speeds, thereby supplying improved analgesia and reducing the rescue analgesic requirements. KEYWORDS Bupivacaine, Dexamethasone, Brachial Plexus, Supraclavicular, Sensory Block

Comparative study of (0.5%) levobupivacaine and (0.75%) ropivacaine in supraclavicular brachial plexus block by lateral approach

2017 ◽  
Vol 5 (6) ◽  
pp. 2426
Author(s):  
Jitesh Kumar ◽  
. Sweta ◽  
Kumari Kanak Lata ◽  
B. K. Prasad ◽  
V. K. Gupta
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Lateral Approach ◽  
Controlled Study ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: As compared to general anaesthesia, brachial plexus block for upper limb surgery gives fewer side effects and better postoperative analgesia. The objective of this study was to evaluate the effects of 0.5% levobupivacaine and compare it with 0.75% ropivacaine.Methods: For this prospective randomized, controlled study, 60 patients of both sexes of ASA grade 1 and 2 were enrolled and divided into two groups and supraclavicular brachial plexus block was performed by lateral approach using 30 ml of 0.5% levobupivacaine and 0.75% ropivacaine. The onset of sensory and motor block, duration of sensory and motor block and analgesia and possible adverse events were recorded.Results: No statistically significant difference was observed in the onset of sensory block in both groups. Onset of motor block was significantly faster in levobupivacaine group (P<0.05). Duration of sensory block, motor block and analgesia was significantly longer in levobupivacaine group (P<0.05).Conclusions: 0.5% levobupivacaine is better alternative to 0.75% ropivacaine in brachial plexus block in term of early onset of sensory block and long duration of analgesia.

scholarly journals Comparison of dexamethasone and midazolam in improving the efficacy of 0.5% bupivacaine in ultrasound guided supraclavicular brachial plexus block.

2020 ◽  
Vol 27 (06) ◽  
pp. 1176-1181
Author(s):  
Umar Iqbal ◽  
Muhammad Akram ◽  
Ahsan Khan ◽  
Amna Qureshi ◽  
Fareeha Sheikh
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Ultrasound Guided ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Time To Onset ◽  
Mean Time

Objectives: The objective of this study was to compare the additive effect of dexamethasone versus midazolam as an adjuvant to bupivacaine for the mean duration of onset of sensory block and duration of analgesia with ultrasound guided supraclavicular block. Study Design: Randomized control trail. Setting: Research was jointly conducted at Arif Memorial Hospital affiliated with Rashid Latif Medical College and KEMU/Mayo Hospital Lahore under the auspices of Department of Anesthesiology. Period: 01/02/2017 to 30/06/2017. Material & Methods: Involved 264 patients of either sex, aged between 20-60 years undergoing upper limb surgery under ultrasound guided supraclavicular brachial plexus block. After obtaining informed consent, patients were randomly allocated into two treatment groups. Along with 0.5% bupivacaine, patients in Group-I received dexamethasone while those in Group-II received midazolam. Outcome variables were mean time to onset of sensory block and mean duration of analgesia which were noted and compared among the groups. Results: The mean age of the patients was 38.90±11.92 years. There were 201 (76.1%) male and 63 (23.9%) female patients in the study group. Majority (79.2%) of the patients belonged to ASA Class-I followed by ASA Class-II (20.8%). Mean time to onset of sensory block was significantly shorter with dexamethasone (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) as compared to midazolam and this difference was significant across all age, gender and ASA groups. Mean duration of analgesia was also significantly longer with dexamethasone (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam and this difference was also significant across all age, gender and ASA groups. Conclusion: Addition of dexamethasone to bupivacaine in ultrasound guided supraclavicular brachial plexus block resulted in early onset of sensory block (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) and longer duration of analgesia (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam in patients undergoing upper limb surgery irrespective of patient’s age, gender and ASA status.

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.

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.

scholarly journals A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block

2021 ◽  
Vol 8 (2) ◽  
pp. 155-160
Author(s):  
Shabeel Aboobacker C P ◽  
Shamjith K ◽  
Melbin Baby ◽  
Salman Mohammed Kutty C
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Tertiary Care ◽  
Random Allocation ◽  
Duration Of Action ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Plexus Block

Brachial plexus block is one of the best surgical technique for upper limb surgeries. It is a good anesthetic and analgesic agent. Though levobupivacaine has a duration of action of three to eight hours it has an acceptable analgesic property and few other practical constraints. Addition of vasoconstrictors like α-adrenergic agonists, hyaluronidase, neostigmine, opioids have been found to be effective. Dexmedetomidine, an α2 receptor agonist has found to be a better adjuvant to levobupivacaine by few literatures. To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 μg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score.This study was conducted after ethical committee clearance in a tertiary care medical college hospital in northern Kerala, India. 60 patients between the age of 18 and 60 years planned for upper limb surgery under brachial plexus block, who fulfilled the inclusion and exclusion criteria were included in the study. A pre anesthetic checkup was done to assess the patient before including in the study. The patients who were included in the study were randomly assigned into two groups – one group received 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine(LD group) and the second group received 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine(LS group) as anesthetic agent through sealed envelope technique. The clinical history, vitals and hemodynamic parameters were monitored and noted prior to and during the surgery. The data collected was analyzed and tabulated. There was no statistically significant difference between both groups with respect to age, Gender and weight signifying proper random allocation of study subjects. None in LD group required post operative analgesia. The mean duration of onset of sensory and motor block was earlier and duration of motor and sensory analgesia was prolonged with the addition of Dexmedetomidine to Levobupivacaine. The hemodynamic stability was better with Dexmedetomidine. Bradycardia was reported in 20% of study participants who were administered dexmedetomidine Dexmedetomidine added to levobupivacaine provides better anesthetic and analgesic care in upper limb surgeries done using brachial plexus block.

scholarly journals Addition of clonidine or fentanyl with bupivacaine for supraclavicular brachial plexus blocks in upper limb surgery - a randomized comparative study

2014 ◽  
Vol 24 (1) ◽  
pp. 3-7
Author(s):  
Nasir Uddin Ahmed ◽  
Mozaffor Hossain ◽  
AKM Akhtaruzzaman ◽  
Montosh Kumar Mondol ◽  
UH Shahera Khatun
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Control Group ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background The popularity of supraclavicular brachial plexus block in upper limb surgery in recent years are due to better understanding of using adjuvant to local anaesthetics, its advantages and in avoidance of the hazards of general anaesthesia. Objective To compare the quality of anaesthesia and duration of analgesia with clonidine-bupivacaine or fentanyl-bupivacaine in supraclavicular brachial plexus block. Method A total number of 60 patients (ASA class 1 and II) were selected randomly into two groups, thirty in each group. Group-A (control group) received fentanyl (100ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.Group-B (study group) received clonidine (150ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.The parameters including pulse rate, non-invasive systolic and diastolic blood pressure, respiratory rate, SpO2, onset and duration of motor and sensory block, post operative pain score in VAS, duration of analgesia, first analgesic demand, side effects were assessed and recorded. Result Onset and duration of sensory block were significantly higher in group-B than in group-A (P<0.001) and motor block were quite prolonged in group-B than group-A (p<0.001), prevalence of sedation in group-B slightly higher than group-A. But intensity of pain measured by VAS in group-A expressed highest at 8 hours of postoperative period and group-B shows highest VAS at 12 hours. Duration of effective analgesia (time from supraclavicular block to first analgesic demand) in study group-B had significantly longer mean duration than that produced by control group-A (14.4 ± 1.3 vs 10.9 ± 1.5 hours; P<0.001). Conclusion Clonidine and bupivacaine combination is a better alternative to fentanyl and bupivacaine in respect of quality of anaesthesia and duration of analgesia. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19792 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 3-7

scholarly journals A Comparative Clinical Evaluation of Efficacy of Tramadol As An Adjuvant To Bupivacaine En Brachial Plexus Block For Upper Limb Surgery

2017 ◽  
Vol 13 (2) ◽  
pp. 13-16 ◽  
Author(s):  
Nabin Kumar Regmi ◽  
Sangeeta Subba ◽  
Uttam Chandra Sharma
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Group I ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: In peripheral nerve blocks, adjuvants are added to local anaesthetics to improve the quality of anaesthesia and analgesia. We designed this randomized single blinded prospective study to compare the analgesic efficacy of tramadol used as an adjuvant to bupivacaine for supraclavicular brachial plexus block in patients undergoing orthopaedic surgeries of upper limb.Aim of study: In this study, we aimed to compare onset, duration and quality of analgesia along with respiratory, hemodynamic changes with tramadol as adjuvant to bupivacaine in supraclavicular brachial plexus block in the patients undergoing upper limb surgery.Method: In this prospective randomized control trial, two groups of 30 patients each were investigated. 28 ml. of 0.5% bupivacaine (plain) with 2 ml. normal saline was administered in group - I and 28 ml. of 0.5% bupivacaine (plain) with 2ml. (100 mg.) tramadol was administered in group - II. The onset of sensory and motor block, duration of analgesia, respiratory/hemodynamic parameters and post-operatively quality of analgesia via visual analogue scale were assessed.Results: The duration and quality of analgesia was significantly increased by adding tramadol in bupivacaine than bupivacaine alone (p=<0.001 and <0.001) whereas there was no statistically significant difference in onset of motor (p=>0.35) and sensory block (p=>0.75) and also hemodynamic and respiratory parameters.(HR p=>0.1, MAP p=>0.5, and SPO p=>0.5).Conclusion: The study suggests that tramadol when added to bupivacaine 2 for supraclavicular brachial plexus block enhances the quality of anaesthesia and analgesia without affecting respiratory/hemodynamic parameters.JNGMC Vol. 13 No. 2 December 2015, Page: 13-16

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