Supraclavicular brachial plexus block using 0.5% bupivacaine with and without fentanyl

Abstract

Introduction: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Objective: To assess the supraclavicular brachial plexus block using 0.5% bupivacaine with and without fentanyl. Materials and Methods: This study design was a prospective randomized controlled double-blinded clinical study was carried out at Department of Anaesthesiology, Shaheed M. Monsur Ali Medical College and Hospital, Sirajganj, Bangladesh from January to June 2021. Fifty (50) patients with American Society of Anesthesiologists physical status Classes I and II, aged 18–50 years, scheduled for upper limb surgery were randomly divided into Two study groups each group contains 25 patients: A Group: receive 0.4 ml/kg bupivacaine up to a maximum of 30 ml volume plus 1ml of normal saline. The dose of bupivacaine was 2 mg/kg.  B Group: Bupivacaine as control group plus 1 mcg/kg fentanyl. Patients were excluded if they had sepsis at the site of injection, body wt<50kg, pregnant women, known hypersensitivity, circulatory instability, diabetes, coagulopathy, history of neurological, renal & liver diseases, mental disease and malignancy. Results: Total 50 patient were included both groups. The groups were comparable with respect to age, height, and weight, and ASA physical status. There was no significant difference in the type and duration of surgery. The characteristics of sensory block are summarized. Demographic characteristics and duration of surgery were comparable in both the groups and the difference was not statistically significant (p>0.05). Duration of sensory and motor blockade was longer in group B and shorter in group A. The differences in duration of sensory and motor blocks were statistically significant in both groups. Pulse rate, blood pressure, oxygen saturation was monitored throughout the surgery and also postoperatively. All values were within the normal range. There was no statistically significant difference between the mean preoperative, intra-operative and postoperative values. The vitals were well maintained in all the patients. The timing of the first rescue analgesia was significantly late and the total consumption of analgesia was significantly less in the first 24 hours in Bupivacaine group. Conclusion: Supraclavicular brachial plexus block using local anesthetic, with or without fentanyl revealed that addition of fentanyl to bupivacaine significantly causes early onset of anesthesia and longer duration of analgesia without any side effects. On the basis of the results of the present study, integrated with understanding from the available literature it may be recommended that, this technique will open new perspective for upper limb surgery under regional anesthesia.