scholarly journals Perineural Dexamethasone Added to Local Anesthesia for Brachial Plexus Block Improves Pain but Delays Block Onset and Motor Blockade Recovery

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. 1-14
Author(s):  
Kenneth D. Candido
Keyword(s):  
Postoperative Pain ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Meta Analysis ◽  
Pain Scores ◽  
Central Registry ◽  
Plexus Block ◽  
Higher Doses

Background: Multiple studies have shown that perineural dexamethasone improves postoperative analgesia. However, some studies have shown minimal benefit, and have raised concerns regarding adverse physio-chemical effects of perineural dexamethasone. Furthermore, there is a paucity of studies wherein control (IV) dexamethasone was considered. Objective: The purpose of this meta-analysis was to evaluate the effectiveness of different concentrations of perineural dexamethasone injection on postoperative analgesia, as well as complications from its use for brachial plexus blocks. Methods: A systematic literature search was conducted using the Cochrane Central Registry of Controlled Trials, PubMed, and Scopus. Trials comparing control and local dexamethasonetreated groups, and those which reported duration of analgesia and/or pain scores/opioid consumptions were selected. Meta-analysis was performed using the Review Manager (RevMan) software 5.1. Results: Fourteen studies consisting of a total of 1,022 patients were included. Perineural dexamethasone significantly prolonged the duration of postoperative analgesia in patients receiving both low-dose (4 – 5 mg) [SMD 2.41 (95% CI: 1.47, 3.35 P = 0<0.00001) I2 = 82%], and higher-doses (8 – 10 mg) [SMD 4.46 (95% CI 3.54, 5.38 P < 0.00001) I2 = 94%]. However, the duration of motor block was also prolonged [SMD 2.52 (95% CI: 1.06, 3.98 P = 0.0007) I2 = 97%] and dexamethasone delayed latency of onset of sensory [SMD -0.49 (95% CI: -0.89, -0.09 P = 0.02) I2 = 76%] and motor [SMD -0.56 (95% CI: -1.13, 0.00 P = 0.05) I2 = 87%] blocks. Postoperative pain scores were improved at both 24 hours [SMD -1.46 (95% CI: -2.43, -0.50 P = 0.003) I2 = 95%] and 48 hours [SMD -1.20 (95% CI: -2.26, -0.13 P = 0.03) I2 = 95%] in dexamethasone-treated groups, whereas opioid consumption was reduced only at 48 hours [SMD -2.97 (95% CI: -4.17, -1.76 P < 0.00001) I2 = 88%]. Complications were comparable between control and dexamethasone-adjuvant groups, except for the excessively prolonged nerve block that was observed predominantly in the dexamethasone-adjuvant group. Limitations: The limitations include different definitions used for the measurements of certain parameters such as the duration of analgesia and duration of motor block, number of studies assessing certain parameters having high heterogeneity, and varying types of local anesthetics used in various studies. Conclusions: Perineural dexamethasone addition to local anesthetic solutions significantly improved postoperative pain in brachial plexus block without increasing complications. However, perineural adjuvant dexamethasone delayed the onset of sensory and motor block, and prolonged the duration of motor block. Smaller doses of dexamethasone (4 – 5 mg) were as effective as higher doses (8 – 10 mg). Key words: Dexamethasone, perineural, brachial plexus block, postoperative pain, metaanalysis, systematic review

TO STUDY AND COMPARE THE EFFECT OF DEXMEDETOMIDINE AND FENTANY AS AN ADJUVANT TO LEVOBUPIVACAINE IN INTERSCALENE BRACHIAL PLEXUS BLOCK FOR HUMERUS SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED STUDY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Kushal Jethani ◽  
Khushboo . ◽  
Anjali Bansal
Keyword(s):  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Controlled Study ◽  
Double Blind ◽  
Interscalene Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Group D

Introduction: Interscalene brachial plexus block provides complete and reliable anaesthesia for surgery of humerus as well as analgesia for postoperative period. Many studies are being done for the search for an adjuvant which when added to a local anaesthetic, prolong the duration of postoperative analgesia. Therefore we compared the effect of fentanyl and dexmedetomidine on postoperative analgesia when added to levobupivacaine for Interscalene brachial plexus block. Material and Methods: In this prospective study, 90 patients were randomly allocated to 3 groups:  Group C (n=30) recieved 30 ml of 0.5% levobupivacaine, Group D (n=30) recieved 30 ml of 0.5% levobupivacaine + dexmedetomidine 1 μg/kg, Group F (n=30) recieved 30 ml of 0.5% levobupivacaine + fentanyl 1 μg/kg. The duration of blockade and analgesia were assessed for all the three groups. Observations: Demographic profile was comparable in all the groups. The onset of sensory and motor block and duration of analgesia and motor block were enhanced in Group D and Group F as compared to Group C. The mean pulse rate and mean arterial pressure were slightly lower in dexmedetomidine group than in other two groups. Results: Compared to the use of levobupivacaine alone for interscalene brachial plexus block, addition of 1 mcg/kg dexmedetomidine or 1 mcg/kg fentanyl to levobupivacaine enhanced the onset of blockade as well as increased the duration of blockade and post-operative analgesia. Also, the blockade characteristics were better improved with addition of dexmedetomidine to levobupivacaine than addition of fentanyl to levobupivacaine without increasing incidence of any unwanted side-effects. Keywords: Interscalene brachial plexus block, Levobupivacaine, Fentanyl, Dexmedetomidine.

scholarly journals Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries

2017 ◽  
Vol 5 (5) ◽  
pp. 1943 ◽  
Author(s):  
Kartheek Hanumansetty ◽  
Hemalatha S. ◽  
Gurudatt C. L.
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Upper Limb ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Peak Effect ◽  
Motor Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: The supraclavicular brachial plexus block has proven to be an important, safer and effective alternative to general anaesthesia in surgeries of upper extremity. Primary aim is to study the effect of addition of dexamethasone to levobupivacaine on postoperative analgesia and secondary objectives are to study onset, peak effect and duration of sensory and motor block in brachial plexus blockade in adult patients posted for upper limb surgeriesMethods: This prospective randomized clinical study was conducted on 60 patients of age 18 to 60 years posted for upper limb surgeries. They were randomly allocated into two groups of 30. In Control group LS (n=30) received Inj. Levobupivacaine 30ml and Inj. Normal saline 2ml. In Study group LD (n=30) received Inj. Levobupivacaine 30ml and Inj. Dexamethasone 2ml (8mg).Results: Both the groups were demographically comparable. Onset of sensory block and motor block in group LD and in group LS were similar (p>0.05). Mean duration of sensory and motor block in group LD was higher than in group LS (<0.001). Duration of postoperative analgesia was 21.20±3.23 hours in group LD and 10.24±1.57 hours in group LS (p<0.001).Conclusions: Dexamethasone added to levobupivacaine for brachial plexus block prolonged the duration of sensory, motor blockade and postoperative analgesia but did not alter the onset time, peak effect time of sensory and motor blockade.

scholarly journals Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus

2021 ◽  
Author(s):  
Ovais Nazir ◽  
Hamid Yatoo ◽  
Shiv Kumar Singh ◽  
Amit Kumar
Keyword(s):  
Brachial Plexus ◽  
General Anaesthesia ◽  
Postoperative Analgesia ◽  
Brachial Plexus Block ◽  
Supracondylar Fracture ◽  
Opioid Consumption ◽  
Pain Scores ◽  
Group I ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children. Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption. Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I. Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.

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 between Single- and Double-Injection Technique for Ultrasound-Guided Supraclavicular Block: A Randomized Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Suresh Kumar Vallapureddy ◽  
Gajanan Fultambkar ◽  
V. Rajeswar Rao ◽  
Vinay Kukreja ◽  
Rammohan Gurram ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Demographic Data ◽  
Controlled Study ◽  
Injection Technique ◽  
Double Injection ◽  
Performance Time ◽  
Plexus Block

<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> &#x3c; 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.

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 Effect of Midazolam and 0.5% Levobupivacaine Combination in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries - A Clinical Study

2016 ◽  
Vol 10 (1) ◽  
pp. 27-33
Author(s):  
Bhawana Rastogi ◽  
Ankush Arora ◽  
Kumkum Gupta ◽  
Manish Jain ◽  
Vijendra Pal Singh ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Ultrasound Guided ◽  
End Points ◽  
Supraclavicular Brachial Plexus Block ◽  
Vas Scores ◽  
The Mean ◽  
Plexus Block

Background: The present study was designed to evaluate the hypothesis that midazolam as an adjuvant to levobupivacaine would safely enhance the duration of analgesia without any adverse effects when compared with levobupivacaine alone, in ultrasound-guided supraclavicular brachial plexus block. Primary end points were the duration of sensory and motor block and secondary end points were sedation score and any other complications. Patients and Method: Eighty consenting patients of both sexes, aged 18-60 years of ASA physical status I-II were randomized into two groups of 40 patients each. Patients in Group LS received 19 ml of 0.5% levobupivacaine with 1 ml normal saline and patients in Group LM received 19 ml of 0.5% levobupivacaine with 1ml midazolam (50µg/kg) for supraclavicular brachial plexus block using ultrasound guidance. Onset time and duration of sensory and motor blockade and VAS scores were assessed as primary end points. Hemodynamic changes, sedation or any other drug or technique related adverse effects were taken as secondary effects. Results: Onset of sensory and motor blockade was lower in patients of Group LM. The mean duration of sensory analgesia was significantly prolonged in patients of Group LM (537.6 ± 101.01 vs. 319.80 ± 87.09 mins). The mean duration of motor blockade was also significantly enhanced in patients of Group LM (405.0 ± 61.62 mins) compared to Group LS (274.8 ± 46.30 mins). VAS scores were higher in Group LS than group LM. Sedation scores were similar in both the groups. Conclusion: Midazolam with 0.5% levobupivacaine has effectively enhanced the duration of sensory and motor block without significant sedation and any other side effect.

Sign in / Sign up

Export Citation Format

Share Document