scholarly journals COMPARISON OF FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED-DOUBLE BLIND PROSPECTIVE STUDY

2016 ◽  
Vol 9 (5) ◽  
pp. 74 ◽  
Author(s):  
Daisy Karan ◽  
Swastika Swaro ◽  
Swarna Banerjee
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACTObjectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to localanesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We comparedthe sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicularbrachial plexus block.Methods: A total of 50 American Society of Anesthesiologist’s Physical Status I and II patients scheduled for elective upper limb surgeries undersupraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 mlbupivacaine with fentanyl 50 µg and Group BD received 30 ml bupivacaine with dexmedetomidine 50 µg. The characteristics for anesthesia andanalgesia were assessed in both groups.Results: Duration of sensory and motor block was 363.4±38.36 minutes and 357±36.77 minutes, respectively, in Group BF while it was452.96±77.12 minutes and 441.52±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motorblock between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF(471.44±65.88 minutes vs. 366.48±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any groupexcept for Grade 3 sedation score which was more in Group BD.Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motorblock and also the duration of analgesia, more than when fentanyl was added to bupivacaine.Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.

Brachial Plexus Block with Ropivacaine, Effects of Added Alpha Adrenergic Agonists - Comparison between Clonidine and Epinephrine

2021 ◽  
Vol 8 (02) ◽  
pp. 97-102
Author(s):  
Pradeep Kumar Das ◽  
Raviteja Vallabha ◽  
Sri Harsha Merugu ◽  
Hemnath Babu Kotla
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Adrenergic Agonists ◽  
Sensory Blockade ◽  
Supraclavicular Approach ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
And Performance ◽  
Plexus Block

BACKGROUND To improve the time of regional anaesthesia many methods have been used. Epinephrine continues to be the most commonly used drug for this purpose. We wanted to compare the effects of alpha-adrenergic agonists clonidine and adrenaline as an adjuvant to ropivacaine in blocking brachial plexus by the supraclavicular approach in patients undergoing upper limb surgeries. METHODS It is a prospective randomised comparative study conducted for 18 months in 40 patients randomly divided into group RA and group RC, conducted on American Society of Anesthesiology (ASA) I and II patients undergoing upper limb surgeries under supraclavicular brachial plexus block. In group RA 30 mL of 0.5 % ropivacaine with 5 microgram / mL of epinephrine was given and in group RC 30 mL of 0.5 % ropivacaine with 1 microgram / Kg of clonidine was given. RESULTS On comparing effects of added alpha-adrenergic agonists clonidine and epinephrine to ropivacaine for supraclavicular brachial plexus block, it was found that there was no significant difference in the onset of the sensory blockade and motor blockade in the two groups. Duration of sensory blockade was significantly more in the clonidine with ropivacaine group when compared with the epinephrine and ropivacaine. There was no significant difference in haemodynamic responses between the two groups. CONCLUSIONS Supraclavicular approach brachial plexus block is effective in terms of cost and performance, and the margin of safety along with good postoperative analgesia. Hence, it can be concluded that the addition of 1 µg / Kg of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block provides a longer duration of analgesia as compared to 5 µg / mL of epinephrine added to 0.5 % ropivacaine. KEYWORDS Ropivacaine, Supraclavicular Brachial Plexus, Epinephrine

scholarly journals A Comparative Study of Bupivacaine 0.5 % and Ropivacaine 0.75 % for Supra-Clavicular Brachial Plexus Block Using Nerve Locator for Elective Upper Limb Orthopaedic Surgeries

2021 ◽  
Vol 10 (24) ◽  
pp. 1825-1829
Author(s):  
Amol Singam ◽  
Punith M. Sirige
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
General Nature ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

BACKGROUND Regional anaesthesia has multiple advantages as compared to general anaesthesia for upper limb surgeries. Here in this study, we wanted to compare bupivacaine 0.5 %, commonly used anaesthetic with ropivacaine 0.75 % which has fewer side effects like cardiotoxicity for supraclavicular brachial plexus block. METHODS A study was performed on 60 ASA I & II patients aged between 18 and 75 years, undergoing upper limb elective surgeries under brachial plexus block using nerve locator. Beginning of sensory and motor block, general nature of block, and terms of sensory and motor blocks were assessed in the C5 to T1 dermatomes. RESULTS There was no statistically significant difference in the onset of sensory and motor blockade between ropivacaine 0.75 % and bupivacaine 0.5 %. Ropivacaine 0.75 % produced similar quality of motor and sensory blockade compared to 0.5 % bupivacaine. The time taken for maximum motor blockade with ropivacaine was comparable with that of bupivacaine 0.5 %. There was no statistically significant difference regarding the duration of analgesia with ropivacaine 0.75 % compared to bupivacaine 0.5 %. Duration of motor blockade with 0.75 % ropivacaine was comparable to that of 0.5 % bupivacaine. CONCLUSIONS Ropivacaine 0.75 % 0.4 ml / kg or 0.5 % bupivacaine 0.4 ml / kg for supraclavicular brachial plexus block produces satisfactory and comparable sensory and motor blockade. It is suggested that lower cardiovascular toxicity of ropivacaine with equal efficacy as bupivacaine in such circumstances may help in reducing the risks to the patient. KEY WORDS Bupivacaine 0.5 %, Ropivacaine 0.75 %, Brachial Plexus Block, Upper Limb Orthopaedic Surgeries

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

scholarly journals COMPARISON OF CLONIDINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO 0.5% BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMISED PROSPECTIVE DOUBLE-BLIND STUDY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Kushal Jethani ◽  
Preeti Sahu ◽  
Seethal Ann
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Double Blind Study ◽  
Nerve Blocks ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Group D

Background and Objectives: Alpha-2 agonists are used as adjuvant with local anaesthetic agents to prolong the duration of spinal, epidural and peripheral nerve blocks as well as to prolong the duration of post operative analgesia. We performed a study to compare clonidine(1ug/kg) and dexmedetomidine (1ug/kg) as an adjuvant to 0.5% bupivacaine in supraclavicular brachial plexus block. Methods: Eighty ASA I and II patients scheduled for elective upper limb orthopaedic surgeries under supraclavicular brachial plexus block were divided into two  groups(n=25 each) in a randomized, double-blinded fashion. Group C received clonidine 1 μg/kg and Group D received dexmedetomidine 1 μg/kg added to bupivacaine 0.5% (30 cc). Onset and recovery time of sensory and motor block, as well as duration of analgesia were studied in both the groups. Results: Duration of sensory block and motor block was 220.12 ±50.3 and 280.1± 20.12 min respectively in group C, while it was 410.34± 60.12 and 460.4 ± 50.56 min respectively in group D and hence both were significantly prolonged in group D.  No statistically significant difference was seen in onset of sensory and motor block between the two groups. The duration of analgesia i.e. time to requirement of rescue analgesia was 270.4± 56.7 mins and 452.7 ±64.23 mins in group C and D respectively and  this difference was statistically significant (P=0.001). Conclusion: Addition of dexmedetomidine to bupivacaine 0.5% in supraclavicular brachial plexus block prolonged the duration of sensory and motor block as well as the duration of analgesia when compared with clonidine. Keywords: Clonidine, dexmedetomidine, supraclavicular block

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.

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 Comparative Study for Anaesthetic Quality with the Addition of Clonidine, Fentanyl or Dexmedetomidine to 0.5℅ Ropivacaine in Supraclavicular Brachial Plexus Block at a Tertiary Hospital

2021 ◽  
pp. 1-3
Author(s):  
Naveen P
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Tertiary Hospital ◽  
Motor Blockade ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
The Difference ◽  
Plexus Block ◽  
Group D

Background: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5℅ ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of sensory and motor blockade, prolongs the duration of the sensory blockade as compared to fentanyl. Dexmedetomidine shortens the onset of sensory and motor blockade much more than clonidine.

scholarly journals A comparative study of Bupivacaine 0.5% versus Ropivacaine 0.5% for supraclavicular brachial plexus block (subclavian perivascular approach only) in ASA II,III patients

2016 ◽  
Vol 2 (10) ◽  
pp. 173
Author(s):  
Natarajan Pooranan ◽  
Dhanasekaran C
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Sensory Blockade ◽  
Peripheral Nerve Blocks ◽  
Supraclavicular Brachial Plexus Block ◽  
Long Acting ◽  
Plexus Block

Peripheral nerve blocks have become important in clinical practice because of their role in post-operative pain relief, shortening of patient recovery time & avoiding risks and adverse effects of general anaesthesia. Bupivacaine is a long acting local anaesthetic. Due to its long duration of action and combined with its high quality sensory blockade compared to motor blockade it has been the most commonly used local anaesthetic for peripheral nerve blocks. Ropivacaine is a newer, long acting local anaesthetic whose neuronal blocking potential used in peripheral nerve blockade seems to be equal or superior to bupivacaine. Studies show that it has significantly greater safety margin over bupivacaine. Hence here is an attempt through the study to compare bupivacaine with ropivacaine in supraclavicular brachial plexus block in ASA II&III patients.

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. 

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