Early and Late Haemodynaemic Effects after Adding Fentanyl to Bupivacaine-Lignocaine Mixtures in Supraclavicular Brachial Plexus Block: A Randomized Control Trial

Background Objectives: Haemodynamic changes are very crucial issues during regional anaesthesia. The purpose of the present study was to observe the immediate and late haemodynaemic effects after adding fentanyl to bupivacainelignocaine mixtures in supraclavicular brachial plexus block. Methodology: This randomized clinical study was conducted in the Department of Anesthesiology in Chittagong Medical College Hospital (CMCH) from March 2011 to May 2012 for a period of one year. All patients with the age group of 18 to 65 years who were selected for upper limb surgery distal to the mid arm were the study population. The random allocation of the patient was done into Group A patients (control group) who were received injection Bupivacaine (0.25%) with injection lignocaine A (1%) with injection Normal saline (0.9%). Group B patients (treatment group) were received injection bupivacaine (0.25%) with injection Ligonocaine A (1%) with injection fentanyl. With all aseptic precaution, supraclavicular brachial plexus block was done using paresthesia technique. Pulse and blood pressure were measured at baseline, intra-operatively and post-operatively. Result: A total of 60 patients were enrolled in this study with 30 patients in each group named group A and group B. The mean age of group A and group B were 32.43±12.25 and 34.90±13.05 respectively (p=0.453). The mean pulse rate of group A (79.53±5.03) and group B (78.10±4.26) at baseline level increased at the time of injection (88.30±5.77 and 85.63±4.87 respectively). At 8 hours interval mean pulse rate of group A was 86.47±5.51 compared to that of group B (86.07±3.08). The mean systolic blood pressure of group A (126.50±18.21) and group B (120.07±11.61) at baseline level increased at 0 minute at the time of injection (129.70±15.34 and 123.17±10.57 respectively). The mean diastolic blood pressure of group A (71.73±11.20) and group B (72.73±11.45) at baseline level increased at 0 minute (75.97±12.74 and 75.80±12.85 respectively). At 8 hrs interval mean diastolic pressure of group A was71.73 ±11.20 compared to that of group B (71.73±11.20). Conclusion: In conclusion there is no significant immediate or late haemodynaemic effects after adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. J Bangladesh Coll Phys Surg 2022; 40: 17-22

Two cases of late-onset cardiovascular toxicities after a single injection of local anesthetics during supraclavicular brachial plexus block - A report of two cases -

Background: Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks.Case: Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient’s blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient’s heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion.Conclusions: Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.

Assessment of Duration of Analgesia after Supraclavicular Brachial Plexus Block Using Bupivacaine With and Without Intravenous Dexamethasone: A Comparative Observational Study

Aim: To compare and analyze the duration of analgesia after giving supraclavicular block using bupivacaine with and without intravenous dexamethasone. Methodology: The study was done in a tertiary care teaching hospital over 06 months. All eligible 50 patients were divided into two groups of 25 each. Group A patients receiving block by 40 ml of 0.25% bupivacaine were compared with Group B patients receiving 40 ml of 0.25% bupivacaine along with 8 mg intravenous dexamethasone. Duration of analgesia was calculated from the time of pain relief after block to the appearance of pain or Numerical Scale Rating (NRS) more than four. Any other complications were also noted. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. As the data was found to be normally distributed bivariate analyses were performed using an independent t-test. Results: Mean duration of analgesia was found to be significantly more among subjects given Analgesia with bupivacaine and iv dexamethasone as compared to subjects given Analgesia with bupivacaine only as p<0.05. No significant difference was seen in the distribution of complications like nausea and vomiting among the two study group when compared using Chi-square test as p>0.05. Conclusion: In conclusion, the addition of dexamethasone supraclavicular brachial plexus block provides prolongation of the duration of the block and decreases the incidence of postoperative nausea and vomiting that may have a great impact on patient comfort.

The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial

Intravenous dexamethasone and dexmedetomidine, in conjunction with peripheral nerve blockade, have each been reported to prolong the duration of analgesia. This study tested whether combined use further prolongs analgesia duration after supraclavicular brachial plexus block (BPB) in patients undergoing orthopedic upper extremity surgery. One hundred twenty patients were randomized 1:1:1:1 to Control (saline bolus and midazolam infusion [0.05 mg/kg loading, 20 µg/kg/h thereafter]); DMED (saline bolus and dexmedetomidine infusion [1 μg/kg loading, 0.4 μg/kg/h thereafter]); DEXA (dexamethasone [10 mg] bolus and midazolam infusion); and DMED-DEXA (dexmedetomidine infusion and dexamethasone bolus) groups. The primary outcome was the duration of postoperative analgesia, defined as the time from the end of the BPB to the first dose of analgesia via a patient-controlled device. Median (interquartile range) times to first dose of analgesia in the Control, DMED, DEXA, and DMED-DEXA groups were 8.1 (6.2–11.6), 9.0 (8.1–11.3), 10.7 (8.1–20.5), and 13.2 (11.5–19.1) hours, respectively (p < 0.001). Pairwise comparisons showed significant prolongation of analgesia in the DEXA included groups compared with the non-DEXA included groups (DEXA vs. control, p = 0.045; DEXA vs. DMED, p = 0.045; DMED-DEXA vs. control, p < 0.001; DMED-DEXA vs. DMED, p < 0.001). A mixed effect model showed that dexamethasone was the only significant factor for the prolongation of analgesia (p < 0.001). Intravenous dexamethasone prolonged the analgesia duration of supraclavicular BPB after orthopedic upper extremity surgery. The concurrent use of mild to moderate sedation dose of intravenous dexmedetomidine in addition to intravenous dexamethasone showed no additional benefit to the prolongation of analgesia.

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

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

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

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