“A COMPARATIVE STUDY BETWEEN 0.25% BUPIVACAINE AND 0.25% BUPIVACAINE WITH DEXAMETHASONE FOR UL-TRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERIES IN INDIAN POPULATION FOR POST OPERATIVE PAIN RELIEF”

Abstract

Background- Brachial plexus blockade has proven a versatile regional anesthetic. It has been given in many ways using blind approach, or using a Peripheral nerve stimulator or under ultra sound guidance. Bupivacaine which has commonly been used has an advantage of being a Long-acting analgesic. Dexamethasone has been widely studied to have an effect on the action of local anesthetic by prolonging their action. Dexamethasone also acts by blocking pain signal transmission and nerve block prolonging effects.

Aim- A comparative study between 0.25% bupivacaine and 0.25% bupivacaine with dexamethasone for ultrasound guided supraclavicular brachial plexus block in upper limb surgeries in Indian population for postoperative pain relief.

Method and materials- this is a prospective randomized comparative study done in department of Anesthesiology, K.E.M. Hospital, Pune in 60 patients from February 2018 to November 2018. Participants will be recruited as patients undergoing upper limb surgery under Brachial Plexus Block Regional anaesthesia in General surgery and orthopedic surgery OT of KEM Hospital, Pune included this study. Informed consent was taken one day prior to surgery while doing pre-anesthetic evaluation from all patients. On the day of surgery all ASA standard monitors were attached which included pulse oximeter, Electrocardiogram, non-invasive blood pressure.  An intravenous line appropriate for the surgical procedure was secured. Pre-operative baseline values of heart rate (HR) ,systolic and diastolic blood pressure (BP) and SpO2 were noted. Patients were the randomly assigned in two groups (30 each) using computer generated sequences. Group A- Patients receiving (30ml 0.25% bupivacaine + 2 ml of N/S) perineurally in the Brachial Plexus using supraclavicular approach. Group B - Patients receiving (30ml of 0.25% Bupivacaine+ 8mg (2ml) Dexamethasone) perineurally with same approach.

Result- The present study comprised of 60 ASA1, 2 patients. The mean ± SD of age of in Group A and Group B was 48.83 ± 18.74 years and 41.77 ± 12.85 years respectively. 30 cases studied in Group A, 13 (43.3%) had Grade 1 ASA, 17 (56.7%) had Grade 2 ASA. Of 30 cases studied in Group B, 15 (50.0%) had Grade 1 ASA, 15 (50.0%) had Grade 2 ASA. (P-value>0.05). The mean ± SD of onset of sensory blockade in Group A and Group B was 22.90 ± 1.79 Mins and 19.85 ± 1.83 Mins respectively. The distribution of mean onset of motor blockade was significantly higher in Group A compared to Group B (P-value<0.001). The mean ± SD of time to rescue analgesia in Group A and Group B was 5.35 ± 1.38 Hrs and 10.58 ± 0.92 Hrs respectively. The minimum – maximum time range in Group A and Group B was 4 – 9 Hrs and 9 – 13 Hrs respectively. The distribution of mean time to rescue analgesia was significantly higher in Group B compared to Group A (P-vale<0.001).

CONCLUSION: It is seen in this study that Single shot Supraclavicular Brachial Plexus Block analgesia was of longer duration in Bupivacaine plus Dexamethasone group than plain Bupivacaine Group. There were statistically significant lower values of VAS PAIN score at various points in Bupivacaine plus Dexamethasone Group. The SBP, DBP and Heart Rate were Significantly on lower side in Bupivacaine with Dexamethasone group which was hemodynamically more stable. Intraoperative and postoperative bradycardia or hypotension was not observed in any group, Postoperative nausea /vomiting were not observed in any group. Hence Dexamethasone added to Bupivacaine for single shot Brachial Plexus Blockade was efficient in prolonging duration of analgesia compared to Bupivacaine only with minimum or no side effects.