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Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial  [cached]
Chakraborty Susmita,Chakrabarti Jayanta,Mandal Mohan,Hazra Avijit
Indian Journal of Pharmacology , 2010,
Abstract: Objective: Clonidine has been used as adjuvant to local anesthetics in order to extend the duration of analgesia in various regional and central neuraxial blocks. It is previously reported that clonidine added to bupivacaine increases analgesia duration in brachial plexus block. We evaluated the effect of this combination in supraclavicular brachial plexus block for upper limb orthopedic procedures. Materials and Methods: A randomized double-blind placebo controlled trial was done with 70 patients of American Society of Anesthesiologists Grade I or II status undergoing upper limb orthopedic procedures. Group A (n = 35) patients received 25 ml of 0.5% bupivacaine and 0.2 ml (30 mcg) clonidine, whereas group B (n = 35) received 25 ml of 0.5% bupivacaine and 0.2 ml normal saline through a supraclavicular approach for brachial plexus block. Vital parameters were recorded 10 min prior to block placement and every 3 min thereafter till the end of the procedure. Onset and duration of both sensory and motor blocks and sedation score were recorded. All patients were observed in postanesthesia care unit and received tramadol injection as soon as they complained of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till injection of rescue analgesic. Results: Analgesia duration was 415.4 ± 38.18 min (mean ± standard deviation) in Group A (clonidine) compared to 194.2 ± 28.74 min in Group B (control). No clinically significant difference was observed in heart rate, blood pressure, and oxygen saturation. Sedation score was higher in the clonidine group. Conclusion: Addition of a small dose of clonidine to 0.5% bupivacaine significantly prolonged the duration of analgesia without producing any clinically important adverse reactions other than sedation.
Extraordinary prolonged blockade following supraclavicular brachial plexus block with bupivacaine.
Jagdish Dureja,Nandita Kad,Jatin Lal,Anil Thakur
Indian Anaesthetists' Forum , 2009,
Abstract: Brachial plexus block is a useful anaesthetic technique for the upper limb surgery using Bupivacaine hydrochloride as anaesthetic agent for the block. A case of extraordinary prolonged block after administration of 0.375 % plain bupivacaine by the supraclavicular route is reported.
Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block  [PDF]
Mohamed Mohamed Abdelhaq, Mohamed Adly Elramely
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.63004
Abstract: Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.
A Comparative Study of Intrathecal Injection of Bupivacaine Alone or with Fentanyl, Clonidine, and Neostigmine in Lower Abdominal Surgeries  [PDF]
Elsayed Mohamed Abdelzaam, Ahmed Hamdy Abd Elrahman
Open Journal of Anesthesiology (OJAnes) , 2019, DOI: 10.4236/ojanes.2019.94009
Abstract: Background: Anesthesiologists are responsible for the development of pain services in the current era. Hence ideal adjuvants that can be used with bupivacaine for stable intraoperative conditions and prolonging the postoperative analgesia with fewer side effects are being investigated. Opioids, despite useful as adjuvants, are associated with undesirable side effects. Aim of the work: The study was done to compare analgesic efficacy and hemodynamic of intrathecal injection of bupivacaine alone or with fentanyl, clonidine, and neostigmine in lower abdominal surgeries, over the first 24 postoperative hours, in a randomized, double-blind, and clinical trial. Methods: 100 Patients were randomized into four equal groups, 25 patients in each group; Group B patients received 2.5 ml of 0.5% hyperbaric bupivacaine and 0.5 ml of normal saline. Group BF patients received 2.5 ml of 0.5% hyperbaric bupivacaine with (25 mics) of fentanyl. Group BC patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.5 ml (75 mics) of clonidine. Group BN patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.1 ml of neostigmine (50 mics) and 0.4 ml of normal saline. Intrathecal anesthesia was done with a recording of parameters intraoperative and the post-operative period. Each patient was assessed for hemodynamic parameters and effective analgesia in operation, and presence of complications (nausea, vomiting, sedation and pruritus) visual analogue pain score (VAS) postoperatively by a blinded investigator in the post-anesthesia care unit (PACU) and at 1, 2, 3, 4, 8 12, 18 and 24 h postoperatively. Results: The postoperative analgesia is more effective with group BC (the gold standard) than group B, group BF, and group BN. As regard complications during the study in all groups, complications as nausea, and vomiting were mainly with group BN; hypotension was primarily in group BC. Conclusion: Bupivacaine clonidine, bupivacaine neostigmine, and bupivacaine fentanyl intrathecal anesthesia produced a longer duration of postoperative analgesia after lower abdominal surgery in patients than bupivacaine alone. Bupivacaine clonidine mixture had the most extended period of analgesia, but with hypotension. So bupivacaine fentanyl mixture with moderate duration of analgesia and minimal side effects is most safe for a patient.
Comparing the Efficacy of Dexmedetomidine When Used as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Blocks under Ultrasound-Guided  [PDF]
Elsayed Mohamed Abdelzaam
Open Journal of Anesthesiology (OJAnes) , 2019, DOI: 10.4236/ojanes.2019.95010
Abstract: Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Patients and methods: This prospective, randomized, single-blind clinical study conducted on 60 patients underwent upper limb surgery done by ultrasound-guided supraclavicular brachial plexus block; these patients allocated into two equal groups: Group I (control) received 20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc (19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results: Demographic data and surgical characteristics were comparable in both groups. The onset times for sensory and motor blocks were significantly shorter in Group II than Group I (P < 0.001), while the duration of blocks was considerably longer (P < 0.001) in Group II. Except for the first recordings (at 0, 5, and 10 min), heart rate levels in Group II were significantly lower (P < 0.001). MBP levels in Group II at 15, 30, 45, 60, 90 and 120 min were significantly lower than in Group I (P < 0.001). The duration of analgesia (DOA) was significantly longer in Group II than Group I (P < 0.001). As regards to the visual Analouge score, there is a highly significant difference at 6 hours, 8 hours and 10 hours in Group II than Group I. Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia.
Rachana Gandhi,Alka Shah,Ila Patel
National Journal of Medical Research , 2012,
Abstract: Introduction: Supraclavicular brachial plexus block provides safe, effective, low cost anaesthesia with good postoperative analgesia. This study was conducted to compare the postoperative analgesic efficacy and safety of dexmedetomidine for brachial plexus blockade along with bupivacaine. Methodology: This prospective double blind study was conducted on 70 patients of age 18 to 60 years posted for various upper limb surgeries and randomly allocated into two equal groups of 35 each. Control group-C received injection bupivacaine (0.25%) 38 milliliter plus 2 milliliter normal saline, dexmedetomidine group-D received injection bupivacaine (0.25%) 38 milliliter plus dexmedetomidine 30 microgram (2 milliliter). Assessment of motor and sensory blockade, pulse, systolic blood pressure, respiration and side effects were noted every 5 minutes for first 30 minute and every 10 minute till end of surgery. Duration of analgesia and incidence of various complications following the procedure were observed. Results: It was observed that in control group onset of motor and sensory blockade was faster. Where as, dexmedetomidine group have better hemodynamic stability and greater postoperative analgesia. Only two cases of bradycardia and two cases of hypotension were noticed in dexmedetomidine group-D. [National J of Med Res 2012; 2(1.000): 67-69]
Buprenorphine as an adjuvant in supraclavicular brachial plexus block.  [cached]
Amol Prakash Singam,Ashok Chaudhari,Manda Nagrale
International Journal of Biomedical and Advance Research , 2012, DOI: 10.7439/ijbar.v3i7.511
Abstract: ABSTRACT Background & Aims: Brachial plexus block is a useful alternative to general anaesthesia. Postoperative analgesia is an added advantage. Buprenorphine, an agonist antagonist opioid has been used by various routes to prolong analgesia. The present study was undertaken to assess the analgesic efficacy of Buprenorphine with Bupivacaine in brachial plexus block. Methods: A prospective, randomized, double blind study was done on 60 adult patients of ASA 1 and 2, aged between 18-50 years and scheduled for various upper limb surgeries. Patients were divided into two groups of 30 each. Group C (control group) received 38ml of inj. bupivacaine 0.25% +2ml normal saline and group B (Buprenorphine group) received 38ml of inj. bupivacaine 0.25% +2ml inj. Buprenorphine (preservative free) (0.3 mg). Patients were observed for onset and duration of motor block, onset and duration of sensory block , duration of pain relief and occurrence of any complications. Results: Post operative analgesia was significantly longer (901.33 ±60.04 min) in group B, as compared to group C (343.00 ±33.02 min) with p value <0.001. Duration of sensory block in group C was 322.16 ±31.80 min and in group B 647.83 ±55.70 min. with p value <0.001. Pain score was significantly low in group B (mean 1.44), compared to group C (mean 5.60) at 12 hours postoperatively. Conclusion: Addition of Buprenorphine 0.3 mg to 38ml of bupivacaine 0.25% for supraclavicular brachial plexus block prolonged sensory blockade and post-operative analgesia without increasing the risk of adverse effects.
Bloqueo supraclavicular bilateral con ecografía Bilateral supraclavicular blockade with ultrasound  [cached]
María Isabel Vásquez,Ana María Jiménez,Oscar David Aguirre,María Patricia González
Revista Colombiana de Anestesiología , 2012,
Abstract: El manejo analgésico de los pacientes con trauma bilateral de hombro o tercio proximal del brazo es difícil. La estrategia multimodal basada en administración de anestésicos locales en el plexo braquial parece ser la más efectiva, pero hacer bloqueos bilaterales tiene riesgos asociados, como son: la parálisis del nervio frénico, la toxicidad por anestésicos locales y el neumotórax bilateral. Estos pueden ser disminuidos con una aproximación supraclavicular al plexo braquial y el uso de ultrasonografía. Describimos el manejo de un paciente con trauma bilateral de hombro y tercio proximal de húmero, quien es llevado a cirugía de osteosíntesis bilateral de húmero y presenta dolor postoperatorio severo que no responde a dosis altas de opiáceos y antiinflamatorios. Es manejado inicialmente con bloqueo supraclavicular bilateral guiado por ecografía con volumen bajo de anestésico local y posteriormente administración continua de bupivacaína, con una valoración del dolor de 2/10 a las 24 h y 3/10 a las 48 h. Concluimos que el bloqueo supraclavicular bilateral es una opción para el manejo del dolor agudo en cirugía de hombro y tercio proximal de húmero. La administración continua de anestésicos locales al plexo braquial contribuye a mantener la respuesta analgésica. Analgesic management in patients with bilateral trauma to the shoulder or the proximal third of the arm is difficult. The multimodal strategy based on the administration of local analgesics to the brachial plexus appears to be the most effective; however, there are risks associated with bilateral blocks, including phrenic nerve palsy, toxicity due to local anesthetics, and bilateral pneumothorax. These risks may be diminished using an ultrasound-guided supraclavicular approach to the brachial plexus. This paper describes the management of a patient with bilateral injury to the shoulder and the proximal third of the humerus. The patient is taken to bilateral humeral fixation surgery and develops severe post-operative pain which does not respond to high-dose opioids and anti-inflammatory agents. He is managed initially with bilateral ultrasound-guided supraclavicular block using a low volume of a local anesthetic followed by continuous administration of bupivacaine. Pain assessment was 2/10 at 24 hours and 3/10 at 48 hours. We concluded that bilateral supraclavicular blockade is an option in the acute management of pain after surgery to the shoulder and the proximal third of the humerus. Continuous administration of local anesthetics to the brachial plexus helps maintain the analgesic response.
Comparison Of Infraclavicular Brachial Plexus Block With Supraclavicular Brachial Plexus Block In Upper Limb Surgeries. (A Study Of 100 Patients)
Sheetal Shah,kamla Mehta,Kirti Patel,Khyati Patel
NHL Journal of Medical Sciences , 2013,
Abstract: Comparative prospective study of two routes of Brachial plexus block – infraclavicular coracoid approach with conventional supraclavicular approach was carried out in 100 patients of ASA RISK I to III, undergoing elective or emergency surgeries on upper limb, at the level of elbow and below elbow. Patients were divided into 2 equal groups, Group I (Infraclavicular) and Group S (Supraclavicular), which were compared for block performance time, onset, quality and duration of block. The applied anatomy, methodology, complications and limitations have been emphasized. The study concludes that infraclavicular brachial plexus block with coracoid approach is a useful block without complications if practiced with precautions.
Minko Minkov,Maria Vankova,Radoslav Minkov,Stefaniya Terzieva
Journal of IMAB : Annual Proceeding (Scientific Papers) , 2012,
Abstract: A hemidiaphragmatic paresis is one of the most frequently observed complications following the supraclavicular anesthesia of the brachial plexus with interscalene approach. In patients, crucially dependant on adequate diaphragmatic function, hemidiaphragmatic paresis may provoke acute respiratory disturbances. The aim of this study was to analyze the anatomical features the brachial plexus with regard of the anesthesia of specific areas of the shoulder and the upper limb.A dissection of the cervical and the brachial plexuses was done in human cadavers. We established that in some cases the phrenic nerve and the accessory phrenic nerve arise from the superior trunk of the brachial plexus. This type of anatomical arrangement significantly increases the risk of hemidiaphragmatic paresis during supraclavicular anesthesia with interscalene approach because the anesthetic tends to invade the supraclavicular space.
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