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 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 Comparison on Brachial Plexus Block Using Local Anaesthetic Agents With and Without Midazolam

2013 ◽  
Vol 3 (1) ◽  
pp. 11-13 ◽  
Author(s):  
Shailendra Nath Gautam ◽  
SK Bhatta ◽  
NR Sharma
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Gaba A ◽  
Medical College ◽  
Anaesthetic Agents ◽  
Plexus Block

Brachial plexus block provide surgical anesthesia and analgesia of upper extremity. Any adjuvant to brachial plexus block have less systemic side effect as well as reduce the total dose local anaesthetics. The midazolam acts on GABA-A receptors in peripheral nerve. The sensory and motor block was significantly faster in our study who received midazolam. This could be local anesthetic properties of midazolam and synergistic action with local anaesthetics. Total 100 patients between ages 10-77 years of either sex of ASA I-III, underwent upper arm surgery were given supraclavicular brachial block with and without midazolam. The onset and duration of sensory block in Gr I (XB) and Gr II (XBM) were significantly different. The onset time for sensory block was significantly prolong and duration of block significantly less compared to Gr II (P<0.05). The onset time for motor block was significantly less and duration significantly higher in Gr II (XBM) as compared to Gr I (XB). Midazolam 50ugm/kg in brachial plexus block speed sensory and motor block with post operative analgesia. Journal of Chitwan Medical College 2013; 3(1): 11-13 DOI: http://dx.doi.org/10.3126/jcmc.v3i1.8458

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 Comparison of bupivacaine with fentanyl and bupivacaine with butorphanol for brachial plexus block by axillary approach- a prospective, double blind, randomized study

2017 ◽  
Vol 5 (4) ◽  
pp. 1415
Author(s):  
Upendrakumar S. Kapse ◽  
Pradnya M. Bhalerao
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Axillary Approach ◽  
The Mean ◽  
Group B ◽  
Plexus Block ◽  
Mean Time

Background: Brachial plexus block by axillary approach achieves good motor sensory and sympathetic blockade below elbow joint. Addition of opioid compounds to local anesthetics improves the block properties and reduces central opioid related side effects. We compared combination of local anaesthetic bupivacaine with fentanyl and butorphanol in axillary block for upper limb surgeries. Aims and objectives were to compare the block quality, duration of sensory and motor block, post-operative analgesia, safety and side effects in two groups.Methods: 60 patients posted for elective or emergency forearm and hand surgeries were randomly divided into 2 groups of 30 each. group B (n=30) received 40ml of 0.25% bupivacaine with butorphanol (25mcg/kg) and group F (n=30) received 40ml of 0.25% bupicaine with fentanyl (1mcg/kg). Onset and duration of sensory block (pinprick) and motor block (Lovett’s rating scale), hemodynamic parameters, postoperative analgesia and side effects were noted in each group.Results: The mean time of onset of sensory block was earlier in group B (2.29±0.62 min) as compared to group F (7.53±2.24 min) in group B. The mean time of onset of motor block was also rapid in group B (4.13±0.78 minutes) than in group F (9.98±2.94 minutes). The mean duration of motor block was longer in group F (9.73±2.48) hours as compared to group B (7.15±2.20) hours in group A. Post-operatively at the end of 10 hours patients in group F were having discomforting pain (65%) as compared to group B who were having distressing and horrible pain (50%) as evaluated by Mc Gill pain questionnaire. Both the groups were hemodynamically stable, no side effects were noted.Conclusions: Onset of sensory and motor blockade was rapid in group B, however group F showed longer lasting motor block and postoperative analgesia. Both groups were hemodynamically stable and without any side effects.

scholarly journals Anaesthetic and analgesic eects of adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block – a comparative study with or without fentanyl

2016 ◽  
Vol 44 (1) ◽  
pp. 26-31
Author(s):  
Farhanaz Zainab ◽  
Mohammad Omar Faruq ◽  
Moumita Talukder ◽  
Sabina Yeasmeen ◽  
AKM Shamsul Alam ◽  
...  
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Plexus Block

Brachial plexus block is gaining popularity day by day for upper extremity surgery because it has manifold advantages. Supraclavicular approach offers a high success rate for elbow, forearm, hand surgery. Different mixtures of local anesthetics are intended to provide faster block onset than long-acting agents and to extend the duration typically seen with intermediate or short-acting agents. This prospective, randomized comparative study was conducted to compare the onset time of sensory block, onset time of motor block and time to achieve complete block, duration of analgesia adding fentanyl with bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. A total of 60 patients fulfilling the inclusion and exclusion criteria were selected for the study & devided into two groups. Group A received lignocaine-bupivacaine mixtures( 1% lignocaine, 0.25% bupivacaine) and was considered control; group Group B received fentanyl (100?g) with the local anaesthetic mixtures( 1% lignocaine, 0.25% bupivacaine). The mean onset of sensory and motor block were significantly early in group B compared with that of group A. The mean time to achieve complete block and duration of analgesia were significantly longer in group B. It was revealed in the study that patients of group B had no pain up to 4 hrs, there was first reporting of pain (VAS >4) around 5 hrs, the worst pain was experienced after 8 hrs, first dose of analgesic was administered according to patient’s request. The patients of group A had no pain up to 3 hrs. Thereafter pain intensity increased at 4 hrs, around 6 hrs postoperatively the patients experienced the worst pain . This feature reveals a significantly longer duration of analgesia in group B. This study revealed that addition of fentanyl significantly causes early onset of anaesthesia and longer duration of analgesia without any side effects.Bangladesh Med J. 2015 Jan; 44 (1): 26-31

scholarly journals Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block

2017 ◽  
pp. E111-E116 ◽  
Author(s):  
Recep Aksu ◽  
Cihangir Bicer
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Ultrasound Guided ◽  
Block Success ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block

Purpose: Research is ongoing to determine the lowest dose of local anesthetics in brachial plexus block that provides adequate anesthesia and postoperative analgesia and reduces complications related to local anesthetics. Methods: Patients 18-65 years of age who underwent upper limb surgery and who received ultrasound-guided supraclavicular brachial plexus block at the Erciyes University Faculty of Medicine Hospital between February 2014 and January 2015 were included in the study (n=50). Supraclavicular brachial plexus blocks were performed on Group B cases by adding 30 ml 0.33% bupivacaine and on Group BD cases by adding 15 ml 0.33% bupivacaine and 1 µg / kg dexmedetomidine. Block success was evaluated by the onset and block duration of motor and sensory block and the duration of analgesia. Results: The block success of Group B and Group BD was 92.6% and 89.3%, respectively (P = 1.000). Onset time of sensory block, degree of sensory block, duration of sensory block, onset time of motor block, degree of motor block and duration of motor block were similar in both groups in the intergroup comparison (P > 0.05). Duration of analgesia and the operative conditions of groups were similar (P > 0.05). Conclusions: In the implementation of ultrasound-guided supraclavicular brachial plexus block, block success, sensory and motor block and analgesia duration were similar for patients anaesthetized with 30 ml of bupivacaine in comparison with dexmedetomidine+bupivacaine (when the bupivacaine dose was reduced by 50% by the addition of the adjuvant).

scholarly journals Experience of using local anesthetic combinations

2021 ◽  
Vol 17 (4) ◽  
pp. 65-68
Author(s):  
Yu.K. Kozlovsky ◽  
A.V. Makogonchuk ◽  
I.Yu. Kozlovska
Keyword(s):  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Study Groups ◽  
Conduction Anesthesia ◽  
Plexus Block

Background. The general toxic effects of local anesthe­tics on vital organs are the most severe side effects of regional blockades. The purpose was to study the effectiveness and safety of combined solutions of local anesthetics in the brachial plexus block. Materials and methods. Forty-nine patients were divided into 2 study groups. The first group (controls) consisted of 24 individuals who received a solution of 0.5% bupivacaine 36 ml (180 mg) with adrenaline 1 : 200,000 as an adjuvant to block the brachial plexus. The second group (main) consisted of 25 patients, who were treated with a mixture of 2% lidocaine 12 ml (240 mg) and 0.5% bupivacaine 12 ml (60 mg) diluted with a solution of 0.9% NaCl 12 ml and adrenaline 1 : 200,000 as an adjuvant. Results. In the first group (bupivacaine), the onset time of sensory block averaged 11.3 ± 4.3 minutes, motor block — 21.0 ± 7.8 minutes. The motor block duration was 894 ± 237 minutes. In the second group (mixture), the onset time of sensory block averaged 8.0 ± 3.6 minutes, motor block — 14.0 ± 6.2 minutes, which was significantly less than in the first group. The duration of the motor block was 539 ± 186 minutes. The longest postoperative analgesia was registered in the bupivacaine group — 984 ± 263 minutes. The duration of postoperative analgesia in the main group was slightly shorter — 612 ± 210 minu­tes. Conclusions. The proposed combination of local anesthe­tics bupivacaine and lidocaine allows reducing the bupivacaine dose by three times, which decreases the toxic complications of conduction anesthesia. The clinical use of the proposed drug combination reduces the duration of the latent period and provides long-term postoperative analgesia.

scholarly journals Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block

2020 ◽  
pp. 50-53
Author(s):  
Omur Ozturk ◽  
Ali Bilge ◽  
Aysu Hayriye Tezcan ◽  
Hatice Yagmurdur ◽  
Gokhan Ragıp Ulusoy ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Brachial Plexus ◽  
Motor Block ◽  
Ultrasound Guidance ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Axillary Brachial Plexus Block ◽  
Tunnel Syndrome ◽  
Plexus Block ◽  
Better Than

Objectives: To compare ultrasound guidance (USG) and electrical neurostimulation guidance (ENSG) in axillary brachial plexus block in terms of block performing time, sensory and motor block quality, and patient satisfaction. Methodology: 200 patients undergoing elective carpal tunnel syndrome surgery were randomly assigned to one of two groups; the USG group or the ENSG group. Axillary blocks were performed with a mixture of 15 ml of lidocaine 2% and 15 ml of bupivacaine 0.5% (a total of 30 ml solution). Sensory block was evaluated with a pinprick test and motor block was evaluated via the Bromage scale by a blinded observer. Results: Block performing time was significantly shorter in the USG group than in the ENSG group (P<0.001). The sensory and motor block onset times were significantly shorter and the additional analgesic requirements were significantly lower in the USG group than in the ENSG group (P<0.001). Conclusion: USG is better than ENSG in axillary brachial plexus block in terms of block performing time, block quality and patient satisfaction. Citation: Ozturk O, Bilge A, Tezcan AH, Tezcan HYAH, Ulusoy GR, Gezgin I, Dost B. Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block. Anaesth Pain & Intensive Care 2016;20(1):50-53.

scholarly journals Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study

2017 ◽  
Vol 5 (5) ◽  
pp. 2139 ◽  
Author(s):  
Shaheena Parveen ◽  
Masrat Jan ◽  
Arshi Taj ◽  
Arif A. Bhat
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Group I ◽  
Supraclavicular Brachial Plexus Block ◽  
Group Ii ◽  
Plexus Block

Background: Supraclavicular brachial plexus block is a good alternative to general anesthesia in surgeries of elbow, forearm, wrist and hand. The aim of this study was to assess the effect of dexamethasone as an adjuvant with bupivacaine in supraclavicular brachial plexus block in upper limb surgeries.Methods: This study was carried out on 60 adult patients of both sexes planned for upper limb surgery during the period from May 2015 to Jan 2016 after approval by the institutional Ethical Committee. Inclusion criteria were American Society of Anesthesiologists physical Status I-II and age between 18 and 50 years. Patients were randomly allocated to two groups of 30 patients each [group I (bupivacaine alone) and group II (bupivacaine + dexamethasone)]. Group I received 30ml of 0.5% bupivacaine with 2ml normal saline while group II received 30ml of 0.5% bupivacaine with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. Statistical analysis was performed with SPSS for Windows (SPSS Inc., Chicago, IL, USA), version 16.0. For analysis of demographic data and comparison of groups, χ2, unpaired Student's t-test and Mann-Whitney U-test were performed. Power of significance p-value of <0.05 was considered to be statistically significant. We evaluated onset, quality and duration of sensory and motor block along with side effects if any.Results: The mean onset of sensory and motor block in Group I and II was statistically insignificant. The duration of motor and sensory block was significantly prolonged in Group II than in Group I. There were no statistically and clinically significant differences in respiratory and hemodynamic parameters.Conclusions: We conclude that dexamethasone as an adjuvant in supraclavicular brachial plexus block prolongs the duration of motor and sensory block with insignificant side effects.

INTERSCALENE BRACHIAL PLEXUS BLOCK WITH A NERVE STIMULATOR FOR CLAVICULAR FRACTURE SURGERY

2014 ◽  
pp. 20-24
Author(s):  
Van Minh Nguyen
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Clavicle Fracture ◽  
Onset Time ◽  
Clavicular Fracture ◽  
Nerve Stimulator ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Objective:To evaluate the effectiveness and side effects, complications of interscalene brachial plexus block with a nerve stimulator for clavicular fracture surgery. Materials and Methods:In a prospective descriptive study, fifty patients received interscalene brachial plexus block for fixation of clavicle fracture. The dose was 7 mg/kg of 1% lidocaine mixed with 1 : 200000 adrenaline. Results:The success rate was 94%, including 4% of patients needed sedation and small amount of narcotic, failure rate was 6%. The minimal stimulating current of the nerve location was 0.46 ±0.08 mA, the onset time of sensory block was 8.86 ±2.65min. There were 3 complications with one Horner’s syndrome and two hoarsenesses. Conclusion:We found that in patients undergoing fixation of clavicle fracture the interscalene block with a nerve stimulator was an effective anesthetic with a low rate of side effects and complications. Key words:Interscalene block, nerve stimulator, clavicular fracture surgery.

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