A COMPARATIVE STUDY OF 0.5 % BUPIVACAINE WITH FENTANYL VERSUS 0.75% ROPIVACAINE WITH FENTANYL IN EPIDURALANESTHESIA FOR ABDOMINAL HYSTERECTOMY

2021 ◽  
pp. 71-73
Author(s):  
Pravin Vijayan ◽  
Debarshi Jana
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Abdominal Hysterectomy ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Study Results ◽  
Duration Of Surgery ◽  
Group B ◽  
Time To Onset

INTRODUCTION Abdominal hysterectomy (AH) is a quite common gynaecological surgical procedure and electively done under central neuraxial blockade. AH is performed for malignant as well as benign indications such as uterine leiomyoma, persistent vaginal bleeding, or pelvic organ prolapse. AIMS AND OBJECTIVES Compare the onset of motor and sensory block. Find out the duration of the sensory and motor blockade. Observe intraoperative hemodynamic changes and assess post-operative analgesia requirements in 24 hour. Duration of analgesia assessed by requirement of rst rescue analgesic. Observe any untoward incident during intraoperative and post-operative period and managed accordingly MATERIALS AND METHODS Study Area: Department of Anesthesiology & critical care, DARBHANGAMEDICALCOLLEGE AND HOSPITAL. Study Population: Adult patients (30- 65 years) undergoing elective abdominal hysterectomy with regional anaesthesia were included for this study. Study Period:January 2019 to March 2020 Sample Design: Subjects were divided into two groups (n=35) equal in numbers and they sampled as per computerized randomization chart. These patients were divided into two groups, group B (with epidural 0.5% bupivacaine and 100g fentanyl) and group R (with epidural 0.75% ropivavaine and 100g fentanyl). Study Design: Prospective, open, randomized, controlled study. RESULTS: In Our study showed that 3.38kg/m2 and 24.86 3.60 kg/m2in group B and R respectively. The duration of surgery was 100.86 9.35minutes and 98.86 8.32 minutes and the duration of stay, was4.86 0.81days and 4.60 0.914 days in group B and group R respectively. Now with comparison of both groups, time to onset of sensory block (uptoT6) has signicant variation. But the other parameters namely, time to onset of motor block, two segment regression or duration of sensory block, rescue analgesia timing and complete motor recovery time were comparable and not signicant statistically in both groups. SUMMARY & CONCLUSIONS To conclude that in the present study using 0.5% bupivacaine with fentanyl and 0.75% ropivacaine with fentanyl epidurally, ropivacaine produced an earlier onset but similar duration of sensory block. The onset, quality and duration of motor block werecomparable in both the groups. It is important that new local anaesthetics with lower cardiotoxic property are adopted to ensure that regional techniques using large amounts of local anaesthetics remain safe with minimal complications. The recovery prole of ropivacaine may be useful where prompt mobilization is require

scholarly journals A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Trishala Jain ◽  
Jaipal .
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Institutional Ethics ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj.  3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally.  Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.

scholarly journals Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

2017 ◽  
Vol 8 (2) ◽  
pp. 59-63
Author(s):  
R Krishna Prabhu ◽  
A Radhakrishnan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Relief ◽  
Blood Loss ◽  
Motor Block ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Group A ◽  
Group B ◽  
Different Doses

Background: Abdominal hysterectomy is often a long duration procedure and warrants intense pain relief in the post-operative period. Dexmedetomidine when added to bupivacaine in subarachnoid block prolongs the duration of surgical anaesthesia, decreases blood loss and prolongs duration of post-operative pain relief. Aims and Objective: To compare two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block in abdominal hysterectomy surgeries. Materials and Methods: 60 patients of age group 30-60 years posted for elective abdominal hysterectomies under American Society of Anaesthesiologists (ASA) physical classification I or II were randomly allocated into 2 groups of 30 each. Group A received 5 micrograms (μg) of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Group B received 10 μg of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Changes in blood pressure, heart rate, respiratory rate, oxygen saturation, ephedrine consumption, blood loss, duration of sensory block, duration of motor block, duration of analgesia were compared between two groups. Results: There was no significant difference in change in heart rate, respiratory rate, oxygen saturation, duration of sensory block, duration of motor block between two groups. Patients in group B had significant decrease in blood pressure, blood loss and significant increase in ephedrine consumption compared to Group A. The duration of analgesia was also prolonged in group B compared to Group A. Conclusion: Dexmedetomidine in dose of 10 μg is a better adjuvant to bupivacaine for abdominal hysterectomy surgeries.Asian Journal of Medical Sciences Vol.8(2) 2017 59-63

scholarly journals Dexmedetomidine and Clonidine as an Adjuvant to Intrathecal Bupivacaine on Spinal Block Characteristic in Gynaecological Procedures - A Prospective Randomised Double-Blind Placebo Controlled Study

2021 ◽  
Vol 8 (19) ◽  
pp. 1363-1368
Author(s):  
Paidikondala L.R.N.N. ◽  
Kommula Gopala Krishna ◽  
Harika Surabattula ◽  
Nagalakshmi N.
Keyword(s):  
Adrenergic Receptor ◽  
Controlled Trial ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Controlled Study ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Double Blind Placebo

BACKGROUND Clonidine and dexmedetomidine are two α-2 adrenergic receptor agonists which have been used as an adjuvant to intrathecal local anaesthetics. Both drugs act by different mechanisms and potentiate the effect of each other. The purpose of the study was to assess the efficacy and safety of adding clonidine and dexmedetomidine to intrathecal hyperbaric bupivacaine on spinal block characteristics in gynaecological procedures. METHODS This study was conducted as a prospective comparative, randomized, double blind, placebo-controlled trial. Based on exclusion and inclusion criteria, 90 patients were included in this study by using a computer generated randomization. Patients were randomly divided into three groups each as follows: Gr BD: 0.5 % hyperbaric bupivacaine (3.5 ml) + 3 μg preservative free dexmedetomidine (total volume of 4 ml), group BC: 0.5 % hyperbaric bupivacaine (3.5 ml) + 0.5 ml clonidine (30 μg) (total volume of 4 ml), group BN (control): 3.5 ml of 0.5 % hyperbaric bupivacaine + same volume normal saline. The spinal block characteristics, hemodynamic stability, and side effects were compared. RESULTS Time to reach sensory block to T10 was 2.52 ± 0.33 minutes in group BN, 1.95 ± 0.38 ms in gr BC and 1.53 ± 0.24 minutes in group BD. The span of sensory block was longer in group BD in comparison to group BC (453.76 ± 52.78 v 389.36 ± 37.4) and group BN (453.76 ± 52.78 vs. 173.33 ± 14.56). Time for rescue analgesia was 169.12 ± 21.14 minutes in group BN, 245.21 ± 32.42 minutes in group BC and 289 ± 24 minutes in group BD. CONCLUSIONS When α-2 adrenergic receptor agonist is used intrathecally with bupivacaine, early motor and sensory block can be achieved along with long span of analgesia. KEYWORDS Bupivacaine, Dexmedetomidine, Clonidine, Spinal Anaesthesia

COMPARISON BETWEEN PERINEURAL DEXAMETHASONE AND INTRAVENOUS MAGNESIUM SULPHATE AS ADJUVANT IN SUPRACLAVICULAR BLOCK

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Nagah El-Shaer ◽  
Ahmed Kamal Mohamed Ali ◽  
Farouk Kamal Eldeen Abd El-Aziz ◽  
Mostafa Samir El-Sayed
Keyword(s):  
Upper Extremity ◽  
Magnesium Sulphate ◽  
Regional Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
University Hospital ◽  
Study Patient ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Abstract   Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time. Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects. Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one). Results From aspect of increasing the duration of sensory &motor block magnesium sulphate group (group A) showed higher prolongation of sensory & motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr. Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).

"COMPARATIVE CLINICAL EVALUATION OF INTRATHECAL ISOBARIC LEVOBUPIVACAINE (0.5%) WITH MORPHINE AND ISOBARIC ROPIVACAINE (0.5%) WITH MORPHINE IN INFRAUMBILICAL SURGERIES -A CLINICAL STUDY”

2021 ◽  
pp. 5-7
Author(s):  
Bhawna Dubey ◽  
Surendra Raikwar ◽  
Vinita Lipton
Keyword(s):  
Clinical Study ◽  
Motor Block ◽  
Intrathecal Morphine ◽  
Sensory Block ◽  
Morphine Group ◽  
Early Recovery ◽  
Rescue Analgesia ◽  
Subarachnoid Block ◽  
Anesthetic Agents ◽  
Duration Of Surgery

Background: Subarachnoid block is a simple technique that provides a deep and fast surgical block through the injection of small doses of local anaesthetic drug in Subarachnoid space. Various local anesthetic agents have been used in subarachnoid block since their introduction, isobaric drugs along with opioids provide excellent combination of shorter motor and longer sensory block which is useful for short duration infraumbilical surgeries. Methods: The present study is a prospective, comparative and clinical study between age group 18-45 years of either sex belonging to ASA grade I and II undergoing elective infra-umbilical surgeries. 40,40 patients were taken into each group. Mean duration of surgery in each group was around 90 minutes. Perioperative vitals like heart rate, blood pressure, oxygen saturation, ECG were recorded. Motor block was assessed through modied Bromage scale and post operative pain was assessed through VAS visual analogue scale , also need for rescue analgesia was monitored postoperatively. Results: We found that 150 microgram intrathecal morphine added as an adjuvant to 0.5% isobaric ropivacaine provided prolonged duration of analgesia and early recovery as compared to 150 microgram intra thecal morphine added with 0.5% isobaric levobupivacaine in patients undergoing infra-umbilical surgeries without causing signicant hemodynamic variation and adverse effects. Conclusion: In present study, we conclude that time of onset of sensory block was more and duration of sensory and motor block was less in isobaric ropivacaine with morphine as compared to isobaric levobupivacaine with morphine. Which revealed that ropivacaine group provides good postoperative analgesia and shorter motor block, that leads to early recovery and better patient satisfaction So, ropivacaine with morphine seems to be better as compared to levobupivacaine with morphine group.

scholarly journals A comparison of intrathecal 0.5% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine for elective surgery: a prospective, randomized, double-blind, controlled study

2021 ◽  
Vol 9 (2) ◽  
pp. 471
Author(s):  
Pallavi Amol Kharat ◽  
Rajshree Chandrashekhar Deopujari
Keyword(s):  
Lower Limb ◽  
Motor Block ◽  
Elective Surgery ◽  
Sensory Block ◽  
Controlled Study ◽  
Complete Regression ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Significant Difference ◽  
Group B

Background: To compare the onset of action, intensity and duration of motor block of 0.5% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine for elective lower abdominal, perineal and lower-limb surgeries.Methods: 70 patients undergoing elective lower abdominal, perineal and lower limb surgery receiving spinal anesthesia were divided randomly into two groups, Group B, (bupivacaine 5 mg/ml with glucose 80 mg/ml;4 ml, and Group R, (ropivacaine 5 mg/ml with glucose 80 mg/ml; 4 ml).Results: The results were analyzed and compared using Chi-square test, student ‘s t-test and Fisher’s exact tests. The onset of sensory block was more rapid with bupivacaine (p<0.05). The maximum cephalad spread was similar in both groups. However, the time required to maximum extent of cephalic spread was less in Group B (p<0.05). Motor block 3 according to modified bromage scale was obtained in both groups and the time to achieve the same was not significant. The duration of motor blockade i.e., time to complete regression of motor block was significantly greater with Group B than with Group R (0.0001). We found that there was no significant difference in the time taken to achieve grade 3 motor block but ropivacaine gave a lesser degree of motor block which regressed faster than bupivacaine (118 min versus 156 min; p<0.0001). There was no significant difference in hemodynamic parameters except that diastolic and mean pressures remained on lower side in group B (p<0.05).Conclusions: We conclude that 0.5% hyperbaric ropivacaine provides a sensory block of similar onset and extent, shorter duration of action and less frequency of hypotension as compared to 0.5% hyperbaric bupivacaine.

scholarly journals Effectiveness of Hyperbaric Ropivacaine over Hyperbaric Bupivacaine in Spinal Anaesthesia

2019 ◽  
Vol 1 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Ramesh Ghimire ◽  
Madhu Gyawali
Keyword(s):  
Motor Block ◽  
Body Wall ◽  
Sensory Block ◽  
Complete Regression ◽  
Hyperbaric Bupivacaine ◽  
Subarachnoid Block ◽  
Hemodynamic Variables ◽  
Block Level ◽  
Group B ◽  
Time To Onset

Introduction: Spinal anesthesia is widely recognized as an alternative to general anesthesia for the surgery in lower extremities, perineum, or lower body wall.  The aim of the study was to compare the effectiveness and safety of hyperbaric Bupivacaine over hyperbaric Ropivacaine. Materials and Methods: We enrolled 60 patients of either sex, ASA grade I &II who were randomly allocated in two groups. Group-B received 3 ml of 0.5% hyperbaric Bupivacaine with glucose 8% and Group-R received 3ml of 0.5% hyperbaric Ropivacaine glucose 8.33%. The various parameters of the subarachnoid block, hemodynamic variables, recovery from sensory and motor blockade, and side effects were studied. Result: The time to onset of maximum sensory block level was faster in Bupivacaine (9.10±3.90min) than in Ropivacaine (10.87±5.37min) and statistically not significant. The time to 5 segments regression was faster in Ropivacaine (116.00±29.72min) than Bupivacaine (143.50±18.76min) and the time to S2 level regression of sensory block was faster in Ropivacaine (154.00±27.84min) than Bupivacaine (186.00±18.73min). The time to onset of the maximum motor was faster with Bupivacaine (8.70±3.19min) as compared to Ropivacaine (13.10±4.40min) The time to regression of motor block by 1 grade was faster with Ropivacaine (97.00±26.64min) than Bupivacaine (146.50±23.53min) and the time to complete regression of motor block was faster with Ropivacaine (149.00±30.75min) than Bupivacaine (183.50±19.96min). Conclusion: The hyperbaric Ropivacaine (3ml, 0.5%) provides a reliable subarachnoid block of shorter duration than hyperbaric Bupivacaine (3ml, 0.5%) with stable hemodynamic parameters. Keywords: Hyperbaric Ropivacaine, Hyperbaric Bupivacaine, Motor, and Sensory Block, ASA

scholarly journals COMPARISION OF ROPIVACAINE AND BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXSUS BLOCK

2020 ◽  
pp. 17-19
Author(s):  
Prajapati Jigar s ◽  
Alka Shah ◽  
Pujaben barad ◽  
Keta Patel ◽  
Dipesh shah
Keyword(s):  
Upper Limb ◽  
Motor Block ◽  
Tertiary Care ◽  
Residual Effect ◽  
Sensory Block ◽  
Toxic Effects ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group B

Background : Regional Anesthesia in the form of supraclavicular approach to the brachial plexus is often used for orthopedic surgeries of the upper limb. It is often used either as an adjuvant to general anesthesia or as the primary anaesthetic. Bupivacaine’s cardiac and central nervous system toxic effects in some patients prompted the researchers to develop new local anesthetic agent with a profile similar to Bupivacaine without considerable toxic effects. One such possible replacement for Bupivacaine was Ropivacaine. However Ropivacaine’s latency of sensory analgesia was approximately two thirds that of Bupivacaine, therefore it was not as effective in promoting prolonged post-operative analgesia. Method : This was a prospective randomized double blinded comparative study on all patients of orthopaedic department affiliated with tertiary care centre who was undergoing upper limb surgery during the study period. Patients with higher ASA grade (3 or 4), with severe morbidity conditions and having allergy to local anaesthetic drugs were excluded from study. A total 60 patients were selected and assigned into two groups randomly (30 in each group).Group A received 20ml of 0.75% of Ropivacaine plus Xylocaine 2% 10 ml while Group B received 20ml of 0.5% of Bupivacaine plus Xylocaine 2% 10 ml by supraclavicular route. Intraoperatively all the vital parameter monitored. At the end of surgery, the residual effect and duration of surgery noted and after shifting of patient to the ward, patients visited for the assessment. Postoperative analgesia assessed by 10 point of visual analogue scale.Results : There was no significant difference regarding age, weight and sex distribution between two groups. The Onset of sensory block of Group R is nearly 7.07+/-0.82 minutes while in Group B it is 7.1+/-0.84 minutes and the Onset of motor block in Group R is 11.23+/-1 minutes while that in group B is 11.2+/-0.99 minutes. The duration of sensory block in Group R is nearly 9.80+/-0.41 hours (548.2 ± 24.62 minutes) while that in Group B is 9.81+/-0.46 hours (589.2 ± 27.74 minutes) and the duration of motor block in Group R is 9.95+/-0.46 hours (534.4 ± 27.65 minutes) while in Group B it is 9.96+/-0.41 hours (596.0 ± 24.70 minutes).Conclusion : Onset of sensory block and onset of motor block in ropivacaine group andbupivacaine group are similar and there are no clinical and statistical differences in the two groups. Duration of sensory and duration of motor blockade in in ropivacaine group and bupivacaine group are similar and there are no clinical and statistical differences in the two groups. No differences are found in in hemodynamic parameters (HR, BP, SPO2) in the two groups. All the patients in two groups were stable hemodynamically during surgery.

scholarly journals Clinical Comparison of Epidural Clonidine and Verapamil with Ropivacaine in Abdominal Hysterectomy; A Prospective, Randomized, Controlled Study.

2020 ◽  
Vol 5 (1) ◽  
pp. 91-95
Author(s):  
Suraj Kumar ◽  
Manoj Tripathi ◽  
Deepak Malviya ◽  
Sujeet Rai ◽  
Sumit Kumar ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Motor Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Epidural Block ◽  
Controlled Study ◽  
Analgesic Requirement ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background: Adjuvants, when combined with local anaesthetics, increase duration of block, improve quality of blockade and accelerate onset of block. The aim of this study is to assess the analgesic properties and postoperative analgesia of Clonidine and verapamil in the epidural block for abdominal hysterectomy.Subjects and Methods:Ninety patients were divided into three groups Group l- patient were given ropivacaine (0.75%) in the dose of 20 ml, Group II -0.75% ropivacaine 20 ml with verapamil in the dose of 2.5 ml, Group III -0.75% ropivacaine 20 ml with Clonidine in the dose of 1mcg/kg body weight. Patients were assessed for onset, degree, level, duration of sensory and motor block, duration of complete analgesia and postoperative analgesia, rescue analgesic requirement, sedation score and adverse effects.Results:When groups I and II were compared, onset of sensory and motor block was found to be statistically insignificant (p>0.05), while it was early in group III in comparison to groups I and II and statistically significant ( p<0.05). The duration of sensory block in group III was more in comparison to groups I and II  and were statistically significant ( p<0.05). The mean duration of analgesia in group I was 184.03 + 5.20 mins, in group II was 300.46 + 5.80 mins and in groups, III was 538 + 12.80 mins.Conclusion:Verapamil does not enhance the onset, duration of the sensory and motor block, though Clonidine in the dose of 1ug/kg enhances the onset of sensory block. The duration of postoperative analgesia with verapamil was more and much higher compared to Clonidine.

scholarly journals A comparative study between the effect of verapamil versus nalbuphine as an adjuvant in supraclavicular brachial plexus block

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mohammed Ibrahim Khamis ◽  
Ahmed Saeed Mohamed ◽  
Hesham Mohamed El Azazy ◽  
Hala Salah El Ozairy ◽  
Mohamed Moien Mohamed
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Normal Saline ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Motor Blockade ◽  
Group A ◽  
Group B ◽  
Plexus Block

Abstract Background Brachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline. Results Results of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block. Conclusion Both drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

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