A PROSPECTIVE STUDY OF EFFICACY OF DEXAMETHASONE USED AS ADJUVANT TO LEVOBUPIVACAINE ADMINISTERED FOR BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH FOR UPPER LIMB SURGERY

2021 ◽  
pp. 9-11
Author(s):  
Avishek Naha ◽  
Sagar Rai ◽  
Amrita Roy ◽  
Gautam Piplai
Keyword(s):  
Brachial Plexus ◽  
Normal Saline ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Plexus Block ◽  
Group D

Many studies have been done on the adjuvants used along with local anaesthetics for Brachial Plexus block. The drug Levobupivacaine has wider margin of safety and has been used in our study along with Dexamethasone as adjuvant. Method: We performed a prospective, randomized, controlled, single blinded study on a total of 70 patients who were randomly allocated into two groups namely Group N (Normal Saline) and Group D (Dexamethasone). Both groups received 28 ml 0.5% Levobupivacaine. Group D received 2 ml (8 mg) Dexamethasone as adjuvant while Group N received 2 ml Normal Saline. Onset of Sensory blockade and motor blockade were measured, respectively, by time taken to loss of pin prick sensation and loss of muscle movement, after administration of drug. Duration of sensory block was measured by time till patient rst reported pain after sensory blockade. Result:The onset time of sensory block was 10.2 ± 1.67 minutes in Group D compared to 12.3 ± 1.88 minutes in Group N (p value <0.0001). The onset time of motor block in Group D was 14.4 ± 1.73 minutes and in Group N 16.3 ± 1.97 min (p value = 0.0002). The duration of sensory block was 944.1± 64.79 minutes in Group D versus 654.7 ± 71.61 min in Group N (p value < 0.0001). Conclusion: It was observed that Group D had signicantly faster onset of sensory and motor blockade while also experiencing longer duration of analgesia.

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.

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 Effect of Verapamil Adjuvant with Local Anaesthetic Mixtures in Supraclavicular Brachial Plexus Block

2019 ◽  
Vol 46 (2) ◽  
pp. 43-47
Author(s):  
Md Arman Ali ◽  
Md Latifur Rahman ◽  
Mehdi Hassan ◽  
Rezwanur Rahman ◽  
Kai Nur Asfia ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Randomized Study ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
P Value ◽  
Group A ◽  
Group B ◽  
Plexus Block

Among the various approaches to block brachial plexus , supraclavicular approach offers a high success rate for elbow, forearm and hand surgery . Various adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and prolong the duration and quality of regional blocks. So efforts were made to combine the adjuvant with local anesthetics to improve patient and surgeon satisfaction. In this randomized study we tried to see the effect of verapamil in brachial plexus block as an adjuvant with local anaesthetic .This randomized study wasconducted in Anaesthesiology department of ShaheedZiaurRahman Medical College Hospital after approved by the ethical review board of this hospital.The study subject were divided into two groups (Group A=only local anaesthetics&Group B=local anaesthetics with Verapamil) , 30 IN numbers in each group. Group-A patients was administered 15ml of 1% lignocaine with 15 ml of bupivacaine 0.25% while in Group-B patients was administered injection verapamil 3.5 ml (3.5 mg) in addition to the above mixture. In this study mean onset time of sensory block was 11.53 ± 1.4 minutes in group - A and 7.12 ± 1.68 minutes in group – B which is not statistically significant (p value = 0.057). The mean onset time of motor block in group A was 15.26 ± 1.96 min, and in group B was 11.58 ± 2.68 min and this difierence isstatistically significant (p value=0.000152). Duration of motor block was 96.30 min and 115.08 min in group A and Group B respectively. Sensory block was 157.26 min and 188.0 min in group A and Group B respectively. Regarding the heart rate, no significant difference was detected between the groups at the time of preanesthesia and at the 5 min after anaesthesia. Compared with group B patients, group A patients shows slight but statistically significant increased heart rate at the 10 min (80, 92 beat/min respectively) after brachial plexus block. At 30 minute after, mean systolic BP was 97.9±4.7 mmHg in group A and 84.3±5.0 mmHg in group B. At 45 minute after, mean systolic blood pressure was 94.6±15.6 mmHg and 84.3±5.0 mmHg in group A and group B respectively. At 60 minutes after, mean systolic blood pressure was 59.6±6.0 mmHg in group A and 61.2±9.4 mmHg in group B. At 15, 30 and 45 minute difference was statistically significant (p<0.05) between two groups. In conclusion, the study revealed that verapamil can be used as an adjuvant to decrease the onset time of sensory and motor blocks of bupivacaine in supraclavicular block. Moreover, verapamil doses in regional blocks did not show any hemodynamic side effects. Bangladesh Med J. 2017 May; 46 (2): 43-47

scholarly journals Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

2019 ◽  
Vol 2 (1) ◽  
pp. 48-54
Author(s):  
Sabin Gauchan ◽  
Samyukta Acharya ◽  
Dikshya Karki
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
P Value ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block ◽  
Group D

Introduction: The objective of this study was to evaluate the effect of 50μg dexmedetomidine on the onset and duration of block and duration of analgesia when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block. Methods: Eighty patients of ASA physical status I and II undergoing elective upper limb surgery under ultrasound guided supraclavicular brachial plexus block were randomly divided into two groups: Group D and Group B. Group D (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml (50 μg) dexmedetomidine. Group B (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml normal saline. Onset time of sensory and motor block, duration of sensory and motor block and duration of analgesia was recorded. Results: Onset time of sensory block (10.55±4.84 min in Group D vs 12.50 ±5.20 min in Group B) and motor block (15.85±5.9min in Group D vs 18.35±5.6min in Group B) though earlier in Group D as compared to Group B was not statistically significant (p value =.087 for sensory block and p value=.058 for motor block). The duration of sensory block (772.20 ±167.84 min in Group D vs 398.38 ±129.839min in Group B) and motor block (725.63±140.964min in Group D vs 361.88±128.764 min in Group B) was statistically significantly prolonged in Group D (p value= .000 for sensory and p value =.000 for motor block). The Duration of analgesia (845.93±184.545min in Group D vs 430.04±121.307 min in Group B) was also statistically significantly prolonged in group D (p value= .000). Conclusions: Dexmedetomidine (50 μg) as an adjuvant to 0.5% bupivacaine solution in ultrasound guided supraclavicular brachial plexus block prolongs the duration (sensory and motor) of block as well as the duration of analgesia with no effect on the onset time of block. Keywords: brachial plexus block; bupivacaine; dexmedetomidine. Correspondance: Dr.

scholarly journals A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

2016 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Naina P Dalvi ◽  
Harshali Salunkhay ◽  
Shubha N Mohite
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Control Group ◽  
Study Group ◽  
Motor Blockade ◽  
Peripheral Nerve Stimulator ◽  
Sensory Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

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.

A rat model of nerve stimulator-guided brachial plexus blockade

2018 ◽  
Vol 53 (2) ◽  
pp. 160-168
Author(s):  
Yanzi Zhang ◽  
Bo Cui ◽  
Chunyu Gong ◽  
Yidan Tang ◽  
Jianxiong Zhou ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Rat Model ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Efficacy And Safety ◽  
Nerve Stimulator ◽  
Sensory Blockade ◽  
Brachial Plexus Blockade ◽  
Plexus Block

It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5–1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

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

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

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

scholarly journals A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section

2019 ◽  
Vol 6 (6) ◽  
pp. 1792
Author(s):  
Kiranpreet Kaur ◽  
Sanjay Johar ◽  
Anil Kumar ◽  
Mamta Jain ◽  
Prashant Kumar ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Pregnant Females ◽  
Haemodynamic Stability ◽  
Group B

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.

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