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Background: Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery. Methods: In this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on. Results: The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D. Conclusions: The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone. Trial registration: This trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn) [ABSTRACT FROM AUTHOR]

Abstract Background Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery. Methods In this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on. Results The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D. Conclusions The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone. Trial registration This trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn )

Introduction: Supraclavicular approaches serve as a common method for administering regional anesthesia in upper limb procedures. In improving the impact with a length of pain relief, medical professionals frequently include additional substances such as dexmedetomidine, buprenorphine, dexamethasone, clonidine, sodium bicarbonate, and tramadol alongside local anesthetics. The intent of this study was to evaluate its impact of incorporating buprenorphine and dexmedetomidine into ropivacaine 0.5%. Materials and Methods: The trial of 90 patients between the ages of 18 and 60, who were identified as American Society of Anesthesiologists Grade 1 and 2, and scheduled upper limb surgery using the supraclavicular approach, were included. They were assigned into distinct groups, each of the groups consisting of thirty individuals. Group R was administered anesthesia consisting of 25 ml of ropivacaine 0.5% along with 1 ml of saline. Group B was administered anesthetics containing ropivacaine 0.5% and buprenorphine, which was diluted in saline. Group D was administered a solution containing ropivacaine 0.5% and dexmedetomidine, which was diluted in saline. Results: Group D had an earlier sensory blockade onset (8.25 min) compared to Group B (9.64 min) and Group R (12.89 min). Group D demonstrated a notably quicker motor blockade onset (9.21 min) in contrast to Group B (12.07 min) and Group R (15.03 min). In contrast with the other groups, Group D exhibited a more longer time frame of both sensory and motor blockades and also an extended period of anesthesia after the surgery. Conclusion: Dexmedetomidine was a more effective adjuvant over buprenorphine in the brachial plexus blocks. This resulted in significantly lower postoperative pain scores at 407.67 min and 612.32 min for the plain ropivacaine and buprenorphine groups, respectively.

Background: Peripheral nerve blockade is a crucial component of comprehensive anesthetic care, providing effective analgesia with fewer side effects than opioids and other oral analgesics. Aims and Objectives: This study investigated the effectiveness of a magnesium adjuvant in an ultrasound-guided supraclavicular brachial plexus block to determine the minimum dose required for the desired effects. Materials and Methods: This prospective, double-blind, and randomized controlled study included 90 patients scheduled for elective upper limb orthosurgery at GTMCH. The 90 patients were divided into three groups: A, B, and C. Each group received 21.5 mL of the test drug, with A receiving ropivacaine and normal saline, B receiving ropivacaine and magnesium, and C receiving ropivacaine and magnesium. Results: There was a significant difference in Group A between the onset of sensory and motor blockade in Groups B and C. There was a significant difference in Group A between the duration of sensory and motor blockade in Groups B and C, but no significant difference was observed between Groups B and C. The visual analog scale score varied from 0 to 6 in Group A and from 0 to 5 in Groups B and C. It was found to be significant only from the 7th to 10th h. There was a significant difference in Group A between Groups B and C in 1st rescue analgesia post-operatively and the number of rescue injections in the first 24 h, but no significant differences was observed between Groups B and C. Conclusion: Both 100 and 150 mg magnesium sulfate with 0.5% ropivacaine in supraclavicular blocks prolonged the blockade duration and reduced analgesic needs.

Background: Numerous medications have been researched in conjunction with local anesthetics to enhance anesthesia quality and offer deep analgesia. In a number of regional methods, clonidine has also been utilized as an adjuvant to local anesthetic drugs. Research on clonidine in brachial plexus block has shown contradictory findings. Aims: To evaluate how tramadol or clonidine affects things in a brachial plexus block: 1) Duration of analgesia (time from block administration to first request for rescue analgesia). 2) The beginning and length of sensory and motor blockade, 3) Pain scores at rest and with movement 4) Any concerns that may arise. Materials and method: prospective, randomized, double-blinded, controlled trial involving 60 patients aged 18-65 years, posted for upper limb surgery were randomly allocated into two groups. Group A received 100 mg of tramadol and group B received 100 µg of Clonidine added to bupivacaine (25 ml 0.5%) solution, in the supraclavicular block. The onset and duration of sensory and motor block was compared along with the duration of analgesia, sedation in both the groups. Patients' pulse rate, blood pressure, saturation was also recorded. Result: In Group Tramadol, the mean Onset Sensory (min) block (mean± s.d.) of patients was 16.33±1.16. In Group Clonidine, the mean Onset Sensory (min) block (mean± s.d.) of patients was 13.10±2.03. Distribution of mean Onset Sensory (min) block with Onset was statistically significant (p<0.0001). In Group Tramadol, the mean Onset Motor (min) block (mean± s.d.) of patients was 22.70±1.60. In Group Clonidine, the mean Onset Motor (min) block (mean± s.d.) of patients was 16.86±1.94. Distribution of mean Onset Motor (min) block with Onset was statistically significant (p<0.0001). Conclusion: This study suggests that, in comparison to tramadol, the addition of clonidine to bupivacaine in supraclavicular brachial plexus block results in a faster onset and longer duration of sensory and motor blockage. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve blockade is a crucial component of comprehensive anesthetic care, providing effective analgesia with fewer side effects than opioids and other oral analgesics. Aims and Objectives: This study investigated the effectiveness of a magnesium adjuvant in an ultrasound-guided supraclavicular brachial plexus block to determine the minimum dose required for the desired effects. Materials and Methods: This prospective, double-blind, and randomized controlled study included 90 patients scheduled for elective upper limb orthosurgery at GTMCH. The 90 patients were divided into three groups: A, B, and C. Each group received 21.5 mL of the test drug, with A receiving ropivacaine and normal saline, B receiving ropivacaine and magnesium, and C receiving ropivacaine and magnesium. Results: There was a significant difference in Group A between the onset of sensory and motor blockade in Groups B and C. There was a significant difference in Group A between the duration of sensory and motor blockade in Groups B and C, but no significant difference was observed between Groups B and C. The visual analog scale score varied from 0 to 6 in Group A and from 0 to 5 in Groups B and C. It was found to be significant only from the 7th to 10th h. There was a significant difference in Group A between Groups B and C in 1st rescue analgesia post-operatively and the number of rescue injections in the first 24 h, but no significant differences was observed between Groups B and C. Conclusion: Both 100 and 150 mg magnesium sulfate with 0.5% ropivacaine in supraclavicular blocks prolonged the blockade duration and reduced analgesic needs. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

Background: Peripheral nerve block analgesia is augmented using dexamethasone with perineural local anesthesia. Aims and Objectives: The study aimed to assess and compare the effects of dexmedetomidine and dexamethasone on the onset and duration of the sensory and motor block when added to 0.5% ropivacaine for the supraclavicular brachial plexus block. Materials and Methods: This randomized controlled study was conducted at the Department of Orthopedics, Government Stanley Medical College and Hospital, Chennai, for 6 months March 2021–September 2021). Eighty patients were randomly allocated into two groups. Group A (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexmedetomidine 50 mcg (0.5 mL)+normal saline (1.5 mL). Group B (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexamethasone 8 mg (2 mL). Results: The dexmedetomidine group had a significantly faster onset of sensory anesthesia (3.9 min) than the dexamethasone group (7.8 min), with a higher duration. The dexmedetomidine group also had a faster onset of motor anesthesia (4.9 min) and a longer duration of analgesia (892.3 min) compared to the dexamethasone group (538 min). The dexmedetomidine group also had a longer duration for rescue analgesia (906 min) than the dexamethasone group (727 min). Visual Analog scores at 10, 14 and 24th h were lower in the dexmedetomidine group than in the dexamethasone group, which is statistically significant (P

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration. [ABSTRACT FROM AUTHOR]

Background: The supraclavicular brachial plexus block (SBPB) stands as a highly efficient regional anesthesia technique predominantly utilized for upper limb surgeries. This study aimed to evaluate the efficacy and safety of incorporating dexmedetomidine (DEX) as a supplement to ropivacaine (Rop) in SBPB management. Methods: The study involved sixty participants meeting inclusion criteria for scheduled surgery and preanesthetic assessment was carried out. Exclusion criteria included various medical conditions and hypersensitivity to study drugs. Participants were randomly assigned to three categories: Category C (Rop only), Category D (Rop with dexmedetomidine), and Category D-IV (DEX only). Assessment parameters included sensory and motor block (SMB) onset times, duration of surgery, quality of anesthesia, pain scores, and adverse events. Statistical analysis was also employed. Results: Demographic attributes were similar across the categories (p > 0.05). Category D demonstrated significantly shorter SMB onset times compared to Category C (p < 0.05). Additionally, Category D exhibited a greater proportion of patients with excellent anaesthesia as compared to Category C and Category D-IV (p < 0.05). Post-operative pain scores were notably lower in Category D compared to Category C and Category D-IV (p < 0.05), with a prolonged duration of analgesia (p < 0.05). Adverse events and sedation scores did not show significant differences among the categories (p > 0.05). Conclusion: The addition of DEX to Rop in SBPB enhances anesthesia quality, accelerates SMB onset, extends the duration of analgesia, and diminishes post-operative pain scores without elevating adverse events. Recommendations: The combination therapy of ropivacaine and DEX could be considered to enhance the efficacy and safety of regional anesthesia techniques. [ABSTRACT FROM AUTHOR]

Background and Objectives: The use of ultrasound has gained popularity in the field of regional anaesthesia for upper limb surgical procedure, as it provides a direct visualization of the anatomic structures and allows a dynamic vision of needle movement and local anaesthetic spread. In the present study, we chose Buprenorphine as an adjuvant to Ropivacaine for ultrasound guided supraclavicular brachial plexus block based on hypothesis that the duration of action after single injection is limited when local anaesthetic alone is used and to prolong its effect, wide range of additives have been used in combination with local anesthetics to promote analgesia. Methodology: After obtaining ethical committee clearance, 60 patients of either sex in the age group of 25 to 60 years, with ASA status I and II, undergoing elective upper limb surgeries under ultrasound guided supraclavicular brachial plexus block, at Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya, were randomly divided into two groups of 30 each. Group RP received Ropivacaine 0.75% 19 ml + Normal saline 1 ml (placebo). Group RB received Ropivacaine 0.75% 19 ml + Buprenorphine 75mcg (1ml). The time of onset and duration of sensory and motor blockade, duration of analgesia, occurrence of haemodynamic instability and adverse events were noted and the results were statistically analyzed, considering a P value of < 0.05 to be statistically significant. Results: The time of onset of sensory block in Group RP was of 6.7±0.51 minutes and in Group RB was of 4.533±0.57 minutes. The sensory block lasted for 334.33±15.01 minutes in Group RP and 606.17±88.29 minutes in Group RB. The onset of motor block in Group RP was 9.3±0.53 minutes and in Group RB was 6.1±0.54 minutes. The motor block lasted for 228.67±11.958 minutes in Group RP and 517.67±103.94 minutes in Group RB. The duration of analgesia in Group RP was 317.50±15.578 minutes and in Group RB was 687.83±19.059 minutes. There was statistically significant difference found between two groups with respect to onset of sensory and motor blockade, duration of sensory and motor blockade and duration of analgesia (with P value <0.001). None of the patients had any other complications in either group. Interpretation and Conclusion: Hence 0.75% Ropivacaine with buprenorphine 75mcg produced satisfactory sensory and motor blockade and also prolonged duration of analgesia when used for supraclavicular brachial plexus block under ultrasound guidance. [ABSTRACT FROM AUTHOR]

Background and objectives: Ropivacaine has reduced risk of cardiotoxicity, neurotoxicity with rapid recovery of motor function. Variety of adjuvants have been used to prolong the duration of local anaesthetic action in regional blocks. Dexmedetomidine is a commonly used adjuant which significantly prolongs the duration of peripheral nerve blocks. we have conducted an observational study on effect of Dexmedetomidine as an adjuvant to Ropivacaine in ultrasound guided supraclavicular brachial plexus blockade in adult upper limb surgeries observed on the basis of onset and duration of analgesia. Methods: After ethical committee approval and informed consent from patients, a prospective observational study was performed on patients scheduled for adult upper limb surgeries. This study was done among two group of patients belonging to ASA 1 and 2. Both the groups of patients were comparable with regard to age, sex, height and weight. Patients who received inj. 0.375% Ropivacaine (25ml) with 1.0 ml isotonic sodium chloride.(n=40) were observed as group 1 and those who received inj.0.375% Ropivacaine (25ml) with 100mcg Dexmedetomidine (1.0 ml)) (n=40) were observed as group 2. Computer software SPSS version-22 (IBM SPSS Statistics, Somers NY, USA) was used for statistical analysis. Independent t test and chi-square test were used and p <0.05 was considered as significant. Results: Mean Time of onset of sensory blockade (mins) in Group 1 was 14.11±1.42mins, in Group 2 was 10.58± 1.56mins. Mean Duration of Analgesia (min) in Group 1 was 724.78 ± 62.43 mins, in Group 2 was 984.56 ± 84.15 mins. Incidence of bradycardia (, p = 0.006< 0.05) were more in patients who received dexmedetomidine. Conclusion Dexmedetomidine as an adjuvant to Ropivacaine in supraclavicular brachial plexus blockade prolongs the onset and duration of analgesia. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided costoclavicular block (CC-approach), an alternative approach to the supraclavicular approach (SC-approach), is a recently described brachial plexus block (BPB). Successful brachial plexus blocks always rely on proper techniques of nerve localization, needle placement and local anesthetic injection. The relevant Sono anatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In the present study, we aimed at comparing the efficacy of supraclavicular brachial plexus block versus costoclavicular brachial plexus block for forearm and hand surgeries for providing surgical anesthesia by evaluating the time of onset of sensory and motor blockade, nerve sparing effect and duration of analgesia in both the groups. Methods: Sixty patients with ASA physical status 1, 2 and 3 undergoing forearm and hand surgeries were taken up for the study. Sixty patients in Group SC (n=30) and Group CC(n=30) received 20 ml 0.5% levobupivacaine by ultrasound guided supraclavicular and costoclavicular BPB respectively. The primary outcome of the study was the time of onset of sensory and motor blockade. Secondary outcome included nerve sparing effect, duration of analgesia and rescue analgesia if used any. Statistical analysis was done with studentt test, unpaired t-test and Fisher exact test. Results: In our study, onset of sensory blockade (9.33 ± 2.41 mins vs11.4 ± 2.989 mins) and onset of motor blockade (11.1± 2.35 mins vs 13.3± 2.87mins) were significantly shorter in group CC when compared to group SC. We did not find any nerve sparing effect in both the groups unlike other studies. Duration of analgesia (10.23±3.013 hours vs 10.56±2.35 hours) and requirement of rescue analgesics were comparable in both the groups. Conclusion: We conclude that ultrasound guided costoclavicular brachial plexus block has shorter procedural time and rapid onset of sensory-motor blockade when compared to supraclavicular brachial plexus block. In addition, it (costoclavicular approach) may provide a promising alternative technique when considering the use of multipoint injection. [ABSTRACT FROM AUTHOR]

Background: Supraclavicular brachial plexus block under ultrasound guidance is the most commonly used technique to provide anaesthesia for upper limb surgeries. Routine methods used for evaluation of block success needpatient co-operation and are time consuming. A successful supraclavicular nerve block is associated with vascular dilation. Perfusion index, which is automatically calculated by pulse oximetry, provides an indication of peripheral perfusion at sensor site. Aim: The aim of study is to assess perfusion indexas a predictor of successful supraclavicular brachial plexus block. The objective of the study is to assess whether PI and PI ratio can be used as an alternative for sensory or motor function tests to assess success of supraclavicular block. Material and Methods: This is a prospective observational study conducted at kamineni institute of medical sciences, Narketpally from March 2023-October 2023. After obtaining informed written consent, total of 60 patients, aged between 20-60 years belonging to ASA physical status 1 and 2, undergoing upper limb surgeries (forearm surgeries) under ultra-sound guided supraclavicular brachial plexus block were included. After local anaesthetic injection, sensory and motor block were assessed every 5 minutes till 20 minutes. Perfusion index (PI) was recorded at baseline and every 5 minutes till 20 minutes after block in both blocked and unblocked upper limb simultaneously. PI ratio calculated as PI at 10 minutes divided by PI at baseline. Results: Perfusion index was higher in blocked limb at all time points compared to baseline and to unblocked limb. Both PI and PI ratio were found statistically significant. Conclusion: PI and PI ratio can be used as an alternative tool to assess the success of supraclavicular brachial plexus block. [ABSTRACT FROM AUTHOR]

Background: Brachial plexus block (BPB) is widely used nowadays in patients undergoing upper limb surgery. Levobupivacaine is one of the best local anesthetics in the current scenario in this field. Both dexmedetomidine (DM) and dexamethasone (DX) are commonly used local anesthetic adjuvants in BPB to enhance blocking effects. In anesthesiology, there is always a search for a better alternative. Aims and Objectives: In this study, we investigated the effect of DM and DX as adjuvants to levobupivacaine on the quality of supraclavicular BPB. Materials and Methods: A prospective, double-blind, randomized controlled intervention study (superiority trial) was done involving 60 patients aged 20–60 years, randomly allocated into two equal groups (group S-DM group-Patients were received Injection 0.25% Levobupivacaine 2 mg/kg body weight+Inj. DM 1 mcg/kg body weight+distilled water [total volume 30 mL] and group C-DX group-Patients received Inj. 0.25% Levobupivacaine 2 mg/kg+Inj. DX 0.1 mg/kg body weight+Distilled water [total volume 30 mL]). The scores of the modified Gormley and Hill scale and the modified Bromage scale were recorded along with hemodynamic parameters. Pearson’s Chi-square test, Mann-Whitney U-test, one-way ANOVA, Kaplan–Meier survival analysis, and Z-test were used for statistical analysis. Results: The onset of motor block was shorter in group-S patients (14.2667±1.0807 [min]) compared to group-C (15.9333±1.5742 [min]), and the duration of motor block was higher in group-S (708.5667±4.2644 [min]) compared to group-C patients (682.3667±20.0095 [min]) (P

AbstractBackground: In our study, we investigated the effect of adding neostigmine to local anesthetic on the supraclavicular brachial plexus block. Patients and Methods: This prospective, randomized, blinded controlled experiment included 80 patients of either sex with an ASA I or II physical status who were planned for forearm operations under ultrasound-assisted supraclavicular brachial plexus block. Participants were separated randomly into two groups and given a supraclavicular block with 25 mL of 0.5% bupivacaine and 1 mL of 0.9 % saline for the control group and 25 mL of 0.5% bupivacaine and 1 mL of neostigmine (0.5mg) for the neostigmine group. Results: In the neostigmine group, sensory and motor blockade began earlier and lasted longer than in the control group. The neostigmine group took substantially longer to seek their first analgesia. The neostigmine group used fewer analgesics in total. At 1, 2, 4, and 6 hours, the neostigmine group had statistically reduced VAS scores than the control group. Conclusion: Patients undergoing forearm procedures benefit from the usage of neostigmine in addition to bupivacaine in ultrasound-assisted supraclavicular brachial plexus block because it reduces the onset of sensory and motor block and lengthens its duration. These results were clear with a dosage of (0.5 mg).

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups. Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia. Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

The advantages of effective postoperative pain management include patient comfort and therefore satisfaction; earlier mobilization, fewer pulmonary/cardiac complications, reduced risk of deep vein thrombosis, speedy recovery with less likelihood of developing neuropathic pain and reduced expenses. Thirty cases in each group were recruited for the study and were randomized to receive Ropivacaine alone or Ropivacaine with Dexmedetomidine. A pilot study was conducted to arrive at the actual mean differences, and the outcome parameters being studied with the visual analogue scale (VAS), Modified Bromage score and mean time for first analgesic requirement. Randomization was done based on computer generated randomization method. There was no statistically significant difference in mean VAS between both the groups at baseline (p=0.784), 5 minutes (p=0.897), 10 minutes (p=0.936), 15 minutes (p=0.196), 30 minutes (p=0.050), 45 minutes (p=0.084), 60 minutes (p=0.084), 75 minutes (p=0.062), and 105 minutes (p=0.141). There was a statistically significant difference at 90 minutes (p=0.044) and from 120 minutes onwards and thereafter (p<0.05) during follow up. Dexmedetomidine group had lower VAS compared to the control group. [ABSTRACT FROM AUTHOR]

Background: Brachial plexus block (BPB) is widely used nowadays in patients undergoing upper limb surgery. Levobupivacaine is one of the best local anesthetics in the current scenario in this field. Both dexmedetomidine (DM) and dexamethasone (DX) are commonly used local anesthetic adjuvants in BPB to enhance blocking effects. In anesthesiology, there is always a search for a better alternative. Aims and Objectives: In this study, we investigated the effect of DM and DX as adjuvants to levobupivacaine on the quality of supraclavicular BPB. Materials and Methods: A prospective, double-blind, randomized controlled intervention study (superiority trial) was done involving 60 patients aged 20-60 years, randomly allocated into two equal groups (group S-DM group-Patients were received Injection 0.25% Levobupivacaine 2 mg/kg body weight+Inj. DM 1 mcg/kg body weight+distilled water [total volume 30 mL] and group C-DX group-Patients received Inj. 0.25% Levobupivacaine 2 mg/kg+Inj. DX 0.1 mg/kg body weight+Distilled water [total volume 30 mL]). The scores of the modified Gormley and Hill scale and the modified Bromage scale were recorded along with hemodynamic parameters. Pearson's Chi-square test, Mann-Whitney U-test, one-way ANOVA, Kaplan-Meier survival analysis, and Z-test were used for statistical analysis. Results: The onset of motor block was shorter in group-S patients (14.2667±1.0807 [min]) compared to group-C (15.9333±1.5742 [min]), and the duration of motor block was higher in group-S (708.5667±4.2644 [min]) compared to group-C patients (682.3667±20.0095 [min]) (P<0.001). Conclusion: DM is a better alternative to DX when added to levobupivacaine for decreasing the onset of sensory and motor block and increasing the duration of supraclavicular BPB. [ABSTRACT FROM AUTHOR]

Background: In our study, we investigated the effect of adding neostigmine to local anesthetic on the supraclavicular brachial plexus block. Patients and Methods: This prospective, randomized, blinded controlled experiment included 80 patients of either sex with an ASA I or II physical status who were planned for forearm operations under ultrasound-assisted supraclavicular brachial plexus block. Participants were separated randomly into two groups and given a supraclavicular block with 25 mL of 0.5% bupivacaine and 1 mL of 0.9 % saline for the control group and 25 mL of 0.5% bupivacaine and 1 mL of neostigmine (0.5mg) for the neostigmine group. Results: In the neostigmine group, sensory and motor blockade began earlier and lasted longer than in the control group. The neostigmine group took substantially longer to seek their first analgesia. The neostigmine group used fewer analgesics in total. At 1, 2, 4, and 6 hours, the neostigmine group had statistically reduced VAS scores than the control group. Conclusion: Patients undergoing forearm procedures benefit from the usage of neostigmine in addition to bupivacaine in ultrasound-assisted supraclavicular brachial plexus block because it reduces the onset of sensory and motor block and lengthens its duration. These results were clear with a dosage of (0.5 mg). [ABSTRACT FROM AUTHOR]

Background and Aims: The primary aim of this randomized controlled study was to evaluate the effect of the addition of dexmedetomidine to ropivacaine on the onset and duration of sensory and motor blockade and the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Materials and Methods: A total of 100 patients of age 18-55 years, planned for elective upper limb surgeries under supraclavicular brachial plexus block using a nerve stimulator, were randomly allocated into two groups. Group 1 (n = 50) received 30 mL 0.5% ropivacaine and 1 mL normal saline and Group 2 (n = 50) received 30 mL 0.5% ropivacaine and 1 µg/kg of dexmedetomidine. The onset and duration of sensory and motor block, duration of analgesia, and adverse events during the perioperative period were noted. Results: The onset of sensory and motor block in Group 1 (16. 26 ± 2.23 and 21.68 ± 2.90 min) was slower than those in Group 2 (9.12 ± 2.40 and 12.68 ± 2.62 min), (<0.001). The duration of sensory and motor block in Group 1 was significantly shorter than those in Group 2 (P < 0.001). The duration of analgesia in Group 1 (402.80 ± 28.21 min) was shorter than that in Group 2 (981.00 ± 92.26 min; P < 0.001). There was no statistically significant difference between the two groups in the incidence of the side effects, except in the incidence of sedation which is significantly higher in Group 2, (P < 0.001). Conclusion: Dexmedetomidine with ropivacaine for supraclavicular nerve block resulted in earlier onset and prolonged duration of the sensorimotor blockade and provided a longer pain-free postoperative period without significant hemodynamic alterations. [ABSTRACT FROM AUTHOR]

Medhat Gamal, Ahmed Hasanin, Nada Adly, Maha Mostafa, Ahmed M Yonis, Ashraf Rady, Nasr M Abdallah, Mohammed Ibrahim, Mohamed Elsayad Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Hasanin, Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt, Fax +20224168736, Email ahmedmohamedhasanin@gmail.comBackground: Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block.Methods: This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis.Results: Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68– 0.87), 0.77 (0.67– 0.86), and 0.79 (0.69– 0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92– 1.00], median nerve 0.97 [0.90– 0.99], radial nerve 0.96 [0.89– 0.99]) with negative predictive value of 100%.Conclusion: Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.Keywords: supraclavicular brachial plexus block, infrared thermography, skin temperature, block failure, analgesia, upper-limb surgery

Background: Regional anesthesia avoids airway instrumentation, preserves conscious level and provide rapid recovery with significant postoperative analgesia. There has always been a search for adjuvants to the regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. The search for the ideal additive still continues, and therefore in this study, we investigated the effects of addition of dexamethasone versus clonidine to levobupivacaine for supraclavicular brachial plexus block. The primary outcome of this study was the onset and duration of sensory block, motor block, and the secondary outcome was postoperative analgesia. Aims and Objectives: The aim of the study was to compare the effect of dexamethasone and clonidine on onset and duration of anesthesia, when used as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. 7. Materials and Methods: In this prospective, double-blind, randomized controlled trial, 60 patients with American Society of Anaesthesiologists physical status I/II scheduled to undergo upper limb surgeries below shoulder were enrolled. The patients were randomly divided into two groups: Group I (n=30): 20 mL of 0.5% isobaric levobupivacaine with 2 mL of dexamethasone. Group II (n=30): 20 mL of 0.5% isobaric levobupivacaine and 30 mcg clonidine (diluted in normal saline, making volume of 2 mL). Results: Clonidine when added to levobupivacaine provide early onset of sensory and motor block but less duration of analgesia and motor blockade as compared to dexamethasone. Conclusion: Dexamethasone should be preferred as compared to clonidine as an adjuvant whenever longer duration of post-operative analgesia is required.

Background: Although nerve block facilitatory effects of dexmedetomidine when used as a perineural adjunct to local anesthetics in supraclavicular brachial plexus blocks are well recognized in multiple studies, but whether this action is at directly on peripheral nerve fibers or is at central level after systemic absorption is unclear. Aim of this study was to evaluate the effect of adding dexmedetomidine 1 microgram/kg to ropivacaine 0.5% in supraclavicular brachial plexus block in terms of duration of analgesia and 24hour cumulative analgesic requirement and to test the hypothesis whether the effect of dexmedetomidine, is due to direct local action on nerve plexus or is centrally mediated after systemic absorption. Methods: 105 patients of ASA grade I and II of either sex undergoing upper limb orthopedic surgeries were divided in 3 groups of 35 patients in each group. Group Rc (control group) received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline; group RDexP received supraclavicular block with 30ml solution of 0.5% ropivacaine+ dexmedetomidine 1mcg/kg and intravenous infusion of 30ml of normal saline; and group RDexIV received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline solution containing dexmedetomidine 1mcg/kg. Primary outcome was duration of analgesia and 24hour cumulative analgesic requirement. Results: The demographic data were comparable in all three groups. Duration of analgesia was longest in group RDexP followed by group RDexIV and least in control group. 24hour cumulative analgesic requirement was least in group RDexP and maximum in group R. 2 patients, one from each group RDexP and group RDexIV reported bradycardia and 6 patients from group RDexIV reported hypotension. Conclusion: We conclude that action of dexmedetomidine is most probably peripheral on brachial plexus nerve fibers directly rather than centrally mediated after systemic absorption.

Background: Brachial plexus block is a useful alternative to general anesthesia for upper limb surgeries providing complete muscle relaxation and stable intra-operative hemodynamics. This study aimed to detect whether ultrasound guided supraclavicular brachial plexus block combined with superficial cervical plexus block is safe and effective for shoulder surgeries or not. Methods: A prospective clinical observational study for detecting efficacy of ultrasound guided supraclavicular brachial plexus block combined with superficial cervical plexus block in shoulder surgeries. Forty-two patients in the age group of 21-60 years undergoing shoulder surgery were assigned to one group. All patients received 30 mL volume of local anesthetics (Lidocaine 2% + bupivacaine 0.5% 1:3 mixture) for supraclavicular block and 10 mL volume of local anesthetics for superficial cervical block. All patients were assessed for: hemodynamics respiratory rate, O2 saturation, sensory block grade, motor block grade, postoperative pain, time for the 1st call for analgesia, the total dose of ketorolac (mg) given in 12 hours after surgery, incidence of failure of sensory and motor block and postoperative complications. Results: As regards mean arterial blood pressure, mean heart rate, oxygen saturation and respiratory rate there were no significant changes. Regarding sensory and motor block assessment, majority 95.2% had Bromage scale III and sensory block grade zero. As regard the postoperative pain, mild pain (VAS 2) occurred which was increasing gradually during 1st 12 postoperative hours. Conclusions: Ultrasound guided supraclavicular brachial plexus block combined with superficial cervical plexus block is safe and effective for shoulder surgeries. [ABSTRACT FROM AUTHOR]

Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events.

Background: Regional anesthesia avoids airway instrumentation, preserves conscious level and provide rapid recovery with significant postoperative analgesia. There has always been a search for adjuvants to the regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. The search for the ideal additive still continues, and therefore in this study, we investigated the effects of addition of dexamethasone versus clonidine to levobupivacaine for supraclavicular brachial plexus block. The primary outcome of this study was the onset and duration of sensory block, motor block, and the secondary outcome was postoperative analgesia. Aims and Objectives: The aim of the study was to compare the effect of dexamethasone and clonidine on onset and duration of anesthesia, when used as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. Materials and Methods: In this prospective, double-blind, randomized controlled trial, 60 patients with American Society of Anaesthesiologists physical status I/II scheduled to undergo upper limb surgeries below shoulder were enrolled. The patients were randomly divided into two groups: Group I (n=30): 20 mL of 0.5% isobaric levobupivacaine with 2 mL of dexamethasone. Group II (n=30): 20 mL of 0.5% isobaric levobupivacaine and 30 mcg clonidine (diluted in normal saline, making volume of 2 mL). Results: Clonidine when added to levobupivacaine provide early onset of sensory and motor block but less duration of analgesia and motor blockade as compared to dexamethasone. Conclusion: Dexamethasone should be preferred as compared to clonidine as an adjuvant whenever longer duration of post-operative analgesia is required. [ABSTRACT FROM AUTHOR]

Background: In this study, we have compared the analgesic effect of addition of dexmedetomidine and clonidine as an adjuvant to 20 ml solution of 0.5% bupivacaine in ultrasound guided supraclavicular brachial plexus block .Dexmedetomidine is an a-2 adrenoreceptor agonist and it can prolong the motor and sensory block for local anaesthesia. It acts by binding to presynaptic C- fibre and postsynaptic dorsal horn neurons. The analgesic action is a result of depression of release of C- fiber transmitters and hyperpolarization of postsynaptic dorsal horn neurons. Methodology: Patient were randomly grouped by close-envelope technique into the three equal group of 30 in each group. Total 90 patients were including in this study. The blind nature of the study was maintained and the study drug is given according as, Group -1: 20 ml of 0.5% bupivacaine.(Control group). Group -2: 20 ml of 0.5% bupivacaine with 1mcg/kg of clonidine and. Group -3: 20 ml of 0.5% bupivacaine with 1mcg/kg dexmedetomidine for spinal anesthesia. Result: Patients in dexmedetomidine group-3 had a significantly longer sensory. Results: Patients in dexmedetomidine group-3 had a significantly longer sensory (546±32.5min) and motor block (442± 42.2min) time as compared to patients in clonidine and control group.(P<0.001). The time for first request of analgesic in the post-operative period was also longer in dexmedetomidine group (445±33.6 min) when compared to bupivacaine (control group) and clonidine group in which it was (292±18.5min) and (362±22.6 min Respectively. (P<0.001). Conclusion: We concluded that dexmedetomidine with bupivacaine for local anaesthesia is associated with more prolonged motor and sensory block than clonidine with bupivacaine and bupivacaine alone. [ABSTRACT FROM AUTHOR]

Purpose: Costoclavicular brachial plexus block has been described recently as a new technique in adults and pediatric patients. In this study, we aimed to compare the supraclavicular and costoclavicular approaches, which are claimed to be effective and practical in pediatric patients. Methods: Sixty children were randomized to receive supraclavicular (SC group) or costoclavicular (CC group) brachial plexus blocks prior to surgical incision. Block performance times were recorded as the primary outcome. Procedural features (ideal brachial plexus cord visualization/needle pathway planning time, needle tip/shaft visualization difficulty, number of needle maneuvers, requirement of extra needle maneuvers due to insufficient local anesthetic distribution) and postoperative pain-related data (sensorimotor block intensities, Wong-Baker and FLACC pain scores and analgesic requirements) were also evaluated. To observe the tendency toward respiratory complications, ultrasonographic diaphragm movement amplitude (with M-mode) and diaphragm thickness (with B-mode) were measured postoperatively. Results: A total of 56 patients were included. Block performance times [70(7–97) vs. 115(75–180) s] were significantly lower in the CC group (p < 0.01). The block success rates did not differ (p > 0.05). The incidence of hemidiaphragm paralysis was 44% in the SC group (p < 0.001), and inspiratory diaphragm thickness was significantly lower (p < 0.01). None of CC group patients experienced hemidiaphragm paralysis. All other parameters were comparable (p > 0.05). Conclusions: Although costoclavicular block did not show superiority in pain management, the block performance was perceived as more practical than supraclavicular block. We believe that costoclavicular brachial plexus block stands as a good option in upper extremity surgeries with the advantages of shorter block performance time and reduced ipsilateral hemidiaphragm paralysis risk in pediatric patients. [ABSTRACT FROM AUTHOR]

Osteogenesis Imperfecta is a collagen disorder of autosomal dominant type caused by mutation of type COLIA-1 and COLIA-2 genes. Orthopaedic surgery in paediatric patient patients of OI is challenging mainly due to difficult airway and risk of malignant hyperthermia. Here we report, a paediatric case of OI with similar family history posted for radius ulna nailing which was managed with total intravenous anaesthesia and supraclavicular brachial plexus block.

Abstract Background Pulse perfusion index (PI) reflects blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently, it is mainly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of the sacral block. Still, there is a lack of relevant research on the impact of brachial plexus blocks. Our objective is to assess the prediction effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. Methods/design This is a mono-center, parallel, 2-arm randomized superiority trial. One hundred four children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into sevoflurane and propofol groups. The PI values of the index and little finger will be recorded on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. The primary outcome is to assess the effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. The secondary outcome includes mean arterial blood pressure (MAP), heart rate (HR), and correlation between baseline PI and 10 min after SCB (PI ratio). Discussion This trial will provide evidence on the changes in PI after SCB in sevoflurane or propofol anesthesia in children. SCB may lead to changes in PI values under sevoflurane or propofol anesthesia. After the children wake up at the end of the surgery, the changes in PI values on the block side and non-block side may be helpful to judge the effect of nerve block when excluding the influence of anesthetics. Trial registration ClinicalTrials.gov NCT04216823 . Registered on 15 July 2020.

Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb. Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB. Materials and Methods: A prospective, randomized, and triple-blind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 μg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 μg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P

Supraclavicular brachial plexus block is well established regional anaesthesia technique for upper limb surgeries. USG guided supraclavicular brachial plexus block provides many advantages but is also associated with the rare complication of recurrent laryngeal nerve palsy, seen in 1.3% of cases. Recurrent laryngeal nerve palsy is mostly documented in right sided supraclavicular blocks than left sided supraclavicular blocks. Here, we report a case of 28 years old male undergoing right upper arm surgery under supraclavicular block who developed hoarseness of voice due to ipsilateral recurrent laryngeal nerve involvement which was followed up properly and managed successfully.

ObjectiveTo determine the median effective volume (EV50) of 0.2% ropivacaine for ultrasound-guided supraclavicular brachial plexus block (SC-BPB) in children aged 1–6 years.MethodsChildren aged from 1 to 6 years with an American Society of Anaesthesiologists (ASA) physical status I–II who were scheduled for unilateral upper extremity surgery at the Children's Hospital of Chongqing Medical University were recruited. All patients underwent surgery under general anaesthesia combined with brachial plexus block. SC-BPB was guided by ultrasound after anaesthesia induction, and 0.2% ropivacaine was given after localization. In the study, we used Dixon's up-and-down approach with an initial dose of 0.50 ml/kg. Considering the effect of the previous block, a successful or failed block could produce a 0.05 ml/kg decrement or increment in volume, correspondingly. The experiment was stopped when there were 7 inflection points. Using isotonic regression and bootstrapping algorithms, the EV50, the 95% effective volume (EV95) and the 95% confidence interval (CI) were calculated. The patients’ general information, postoperative pain scores, and adverse events were also recorded.ResultsTwenty-seven patients were involved in this study. The EV50 of 0.2% ropivacaine was 0.150 ml/kg (95% CI, 0.131–0.169 ml/kg) and the EV95 (secondary metric) was 0.195 ml/kg (95% CI, 0.188–0.197 ml/kg). No adverse events occurred during the research study.ConclusionsFor ultrasound-guided SC-BPB in children aged 1–6 years undergoing unilateral upper extremity surgery, the EV50 of 0.2% ropivacaine was 0.150 ml/kg (95% CI, 0.131–0.169 ml/kg).

Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events. [ABSTRACT FROM AUTHOR]

Background: Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post-operative pain control. Objective: The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block. Methods: This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month). Results: There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 6 47.97 mins, group B: 610.5 6 57.9 mins) and motor (group A: 660.5 6 47.29 mins, group B: 625.5 6 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 6 48.74 mins, group B: 618 6 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 6 1.56 mg). Conclusion: This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block . . ..etc), the difference between the two groups was also significant statistically. [ABSTRACT FROM AUTHOR]

Background: 0.75% Ropivacaine alone and 0.75% Ropivacaine with adjuvant Fentanyl 2 micrograms per kg body weight should be quantitatively compared for supraclavicular brachial plexus block. investigate how long analgesia lasts and when it starts. Material and Methods: The institution's ethical committee approved a prospective randomised double-blind trial performed by Department of Anesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India, from July 2022 to November 2022. The investigation included 60 ASA I and II upper limb surgery patients ages 20 to 60. All patients' sensory block (analgesia) onset and duration were evaluated. Student 'T' test determined if two groups differ significantly. A "p" value of 0.05 or less was considered statistically significant, while >0.05 was not. Results: A group contains 20 men and 10 women and group B contains 19 men and 11 women. Mean Age for group A is 34.86 + 5.3 and group B is 36.5 + 6.2. P value 0.2 is not significant. Both groups are equal statistically. Group A's mean onset is 28.18 + 2.26 while Group B's is 14.5 + 10.75. P = 0.001 shows a highly significant difference in onset time. Group A action last for 7.4 + 2.26 minutes. Group B's mean action time is 9.47+1.95. p value of 0.01 indicates a statistically significant difference in action duration, Mean onset time varies (p <0.001), Mean duration of action also changes (p <0.01) in between two groups. Conclusion: In this investigation, adding 2 micrograms of Fentanyl per kg to 0.75 percent ropivacaine accelerated the onset of effect. And also Fentanyl infusion prolongs 0.75% ropivacaine's effect in supraclavicular brachial plexus block. [ABSTRACT FROM AUTHOR]

Background: The anaesthetic sector makes substantial use of local anaesthetic drugs, although anaesthetists have challenges due to the diverse local anaesthetics' short acting times. Numerous perineural adjuvants have been explored to speed up the onset and prolong the analgesic effects of nerve blocks. The role of central sensitizations and N-methyl-D-aspartate (NMDA) receptors in post-operative pains has been highlighted by the acquaintance with pain mechanisms. Objective: The current study aimed to compare the effect of magnesium sulfate (100 mg in 1mL volume) and Dexmedetomidine (100 mcg in 1mL volume) added to lidocaine (20 ml 2%) on the onset time and duration of supraclavicular brachial plexuses block in patients undergoing upper limb surgery. Patients and methods: This prospective randomized-controlled study included 60 patients that were subjected to surgical procedure in upper limb as part of the standard anesthetic techniques. Results: There was statistically significant increase of the duration of motor and sensory block among group D than in group M. Duration of motor block for group M was 277.17 ± 54.34 min versus 482.50 ± 72.75 min for group D. Time to first analgesia for group M was 5.10 ± 1.56 h versus 8.70 ± 3.38 h for group D. A statistically high significant increase total dose of analgesia consumed was detected for group M as compared to group D (8.80 ± 2.44 mg for group D versus 12.53 ± 4.03 mg for group M). Conclusion: Addition of magnesium sulfate or dexmedetomidine to lidocaine in supraclavicular brachial plexus block prolong the duration of sensory and motor block. Both magnesium sulfate and Dexmedetomidine groups showed improved postoperative analgesia with less analgesic requirements. [ABSTRACT FROM AUTHOR]

Background and objective Ultrasound-guided supraclavicular brachial plexus block has revolutionized the anesthesia practice, and a single injection can facilitate the rapid onset of anesthesia. Ropivacaine has replaced bupivacaine due to its enhanced cardiovascular and neurological safety profile. Several clinical investigations have demonstrated that magnesium sulfate administration during peripheral nerve blocks can reduce the anesthetic requirements and postoperative analgesic consumption. In this study, we aimed to compare the analgesic efficacy of perineural magnesium sulfate versus intravenous (IV) magnesium sulfate as an adjuvant to ropivacaine in patients undergoing upper limb orthopedic surgeries under supraclavicular brachial plexus block. The secondary objectives included analyzing the duration and onset of sensorimotor blockade, total doses of rescue analgesic administered, hemodynamic profile, and adverse effects. Methodology We conducted a prospective randomized study involving 50 patients with the American Society of Anaesthesiologists (ASA) grade I and II who were aged 18-60 years and scheduled for elective upper limb orthopedic surgeries to treat both-bone forearm fractures. We adopted a single-blinded study design and patients were randomly allocated into two groups based on a sealed opaque envelope technique. Both groups received 0.75% ropivacaine 20 ml; in addition, Group IV Mg received 2 mL of normal saline and Group perineural Mg received 150 mg of magnesium sulfate (2 ml) as additives, amounting to a total of 22 ml for supraclavicular brachial plexus block. Group IV Mg received an injection of magnesium sulfate 150 mg in 100 ml of isotonic saline IV whereas Group perineural Mg received 100 ml of isotonic saline IV 30 minutes before the administration of supraclavicular brachial plexus block. Results Both groups were statistically comparable in terms of all demographic variables, ASA grading, and duration of surgery. Duration of analgesia was prolonged in Group perineural Mg (616.48 ± 92.396 min) vs. Group IV Mg (459.81 ± 82.984 min) (p = 0.001). The duration of sensory and motor blockade was significantly higher in Group perineural Mg when compared to Group IV Mg (p<0.001). Intraoperative hemodynamic parameters were comparable between the groups, and no side effects were reported in either of the groups. Conclusions Based on our findings, magnesium sulfate administered perineurally as an additive in the supraclavicular brachial plexus block is associated with a superior duration of analgesic effect when compared to the IV route. Perineural magnesium sulfate is also more effective in increasing the duration of sensorimotor blockade., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethical Committee, Rajarajeswari Medical College and Hospital issued approval RRMCH-IEC/228/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ramegowda et al.)

Background: Flexor tendon injuries represent a significant per-centage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients under-going flexor tendon repair. Patients and Methods: In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results: Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is sig-nificantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01). Conclusion: WALANT anesthesia was found to be better alter-native to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction. [ABSTRACT FROM AUTHOR]

Background: Pulse perfusion index (PI) reflects blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently, it is mainly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of the sacral block. Still, there is a lack of relevant research on the impact of brachial plexus blocks. Our objective is to assess the prediction effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia.Methods/design: This is a mono-center, parallel, 2-arm randomized superiority trial. One hundred four children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into sevoflurane and propofol groups. The PI values of the index and little finger will be recorded on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. The primary outcome is to assess the effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. The secondary outcome includes mean arterial blood pressure (MAP), heart rate (HR), and correlation between baseline PI and 10 min after SCB (PI ratio).Discussion: This trial will provide evidence on the changes in PI after SCB in sevoflurane or propofol anesthesia in children. SCB may lead to changes in PI values under sevoflurane or propofol anesthesia. After the children wake up at the end of the surgery, the changes in PI values on the block side and non-block side may be helpful to judge the effect of nerve block when excluding the influence of anesthetics.Trial Registration: ClinicalTrials.gov NCT04216823 . Registered on 15 July 2020. [ABSTRACT FROM AUTHOR]

Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb. Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB. Materials and Methods: A prospective, randomized, and tripleblind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 µg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 µg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P<0.001). The duration of post-operative analgesia was also longer in the BD Group compared with the BF Group (549.43±10.56 vs. 403.69±10.84) P<0.001. BF Group had more requirements of analgesic postoperatively. Conclusion: Addition of dexmedetomidine to bupivacaine prolonged the duration of perineural supraclavicular BPB and improvement of post-operative analgesia than fentanyl without significant side effects in patients undergoing upper limb surgeries. [ABSTRACT FROM AUTHOR]

Background and Aims: Levobupivacaine, a less cardiotoxic s-isomer of bupivacaine, is proved to be similar to bupivacaine, hence, proposed as a safer alternative for nerve blocks. We aimed to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block (BPB) performed with levobupivacaine. The aim of this study is to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular BPB performed with levobupivacaine. Material and Methods: A prospective, randomized double-blind control trial done on 120 patients undergoing elective upper limb surgical procedures under supraclavicular BPB. The enrolled patients were allocated to one of the three groups: Group L - 0.5% levobupivacaine +0.9% normal saline (NS) IV infusion; Group LDI - 0.5% levobupivacaine + dexmedetomidine (1 mcg/kg) in NS IV infusion; and Group LDP - 0.5% levobupivacaine +1 mcg/kg of dexmedetomidine perineural + NS IV infusion. The onset and duration of sensory and motor blockade were recorded in minutes. One-way ANOVA was used to observe any differences between the groups, and post hoc comparisons were conducted after Bonferroni correction for multiple comparisons. Results: The onset of sensory and motor blockade in Group LDP was significantly shorter than Group L and Group LDI. The duration of sensory blockade in Group LDP was significantly longer than Group LDI and Group L. The duration of motor blockade in Group LDP was prolonged compared to Group LDI and Group L. Conclusions: When dexmedetomidine is added as adjunct to levobupivacaine in supraclavicular BPB, onset of sensory and motor blockade is faster in perineural group, whereas duration of sensory and motor blockade and duration of analgesia are more prolonged when used perineurally than intravenously.

Background: Brachial plexus block is a key technique in anesthesiologist’s practice. Ropivacaine is a long acting local anaesthetic, Dexmedetomidine has been included as an adjuvant to enhance block duration. Aim: To elucidate the effect of addition of Dexmedetomidine to Ropivacaine in ultrasound guided parasagittal supraclavicular brachial plexus approach with respect to duration of analgesia, onset and duration of sensorimotor blockade. Methods: A randomized single blinded prospective clinical study was conducted among Forty patients of 20-50yrs, ASA Grade I and II, weighing >60kgs scheduled for elective upper limb orthopedic surgeries. Group RN received 25ml of 0.75% ropivacaine with 1ml normal saline, Group RD received 25ml of 0.75% ropivacaine with 1mcg/kg dexmedetomidine diluted to 1ml. Analgesic efficacy, sensorimotor blockade was determined. Statistical Analysis: Demographic and hemodynamic data was analyzed using student t-test. Unpaired t-test was used to analyze onset, duration of sensorimotor blockade and analgesic duration. Results were statistically significant if p-value

Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents to provide prolonged analgesia in peripheral nerve blocks. This study aimed at determining the optimal dose of dexmedetomidine, which when combined with ropivacaine will produce a superior quality block in terms of extended pain-free period and reduced perioperative analgesic/opioid use, which in turn improves patient satisfaction. Objective: The objective of the study is to assess the duration of analgesia with two different doses (25 μg and 50 μg) of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block. Subjects and Methods: This prospective randomized controlled study included 50 patients undergoing upper limb surgeries under supraclavicular brachial plexus block randomly divided into two groups. Group D25 received 29 mL of 0.5% ropivacaine +25 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL); Group D50 received 29 mL of 0.5% ropivacaine +50 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL). Onset and duration of sensorimotor block, duration of analgesia, and time interval for the rescue analgesia and hemodynamic stability were observed. Results: The mean onset of motor and sensory block was significantly higher in the D25 group (P = 0.001). The Visual Analog Scale pain scores and rescue analgesia consumption were significantly lower in the D50 group (P = 0.013, 0.001). The duration of analgesia was significantly higher in the D50 group (P = 0.001). Conclusion: Dexmedetomidine 50 μg is an effective adjuvant dose to ropivacaine with insignificant hemodynamic changes with better duration of analgesia and lesser pain scores. [ABSTRACT FROM AUTHOR]

Background: Skillful usage of adjuvants in peripheral nerve blocks can resolve the key issue of postoperative pain. This study was conducted to compare the effects of dexmedetomidine as an adjuvant with bupivacaine in terms of the duration of analgesia (DOA), onset and duration of sensory and motor block. Materials and Methods: This prospective, randomized, double-blind trial consists of total 72 patients undergoing elective upper limb elective procedures, divided into two groups, 36 in each. Group-C received ultrasound-guided (USG) supraclavicular brachial plexus block using injection 0.25% bupivacaine 20 ml + 0.9% normal saline diluted to total 22 ml and Group D received USG supraclavicular brachial plexus block using injection 0.25% bupivacaine 20 ml + dexmedetomidine 1 μg/kg diluted to total of 22 ml with 0.9% normal saline. The parameters recorded were onset and duration of sensory and motor block, DOA, and side effects. Results: In both the groups, demographic data were similar. Sensory and motor block onset was significantly shorter (P < 0.05) in Group D than Group C, while the duration of blocks and DOA was prolonged in Group D (P < 0.05). Intraoperative hemodynamics were significantly lower in Group D except in two patients, who had bradycardia and were treated. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in USG supraclavicular plexus block shortens the onset and prolongs the duration of sensory and motor block and DOA.

Background and Aims: Both dexmedetomidine and dexamethasone have individually been shown to be beneficial as an adjuvant to ropivacaine. We compared the efficacy of combination of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in ultrasound-guided supraclavicular brachial plexus (SCBP) block. Material and Methods: In this prospective randomised double-blind controlled trial, 60 ASA physical status I/II patients undergoing elective upper-limb surgery under ultrasound-guided SCBP block with 30 ml of 0.5% ropivacaine were randomised into three groups. Group 1 (n = 20) received 1 μg/kg of dexmedetomidine, and group 2 (n = 20) received 8 mg of dexamethasone in addition to ropivacaine, while group 3 (n = 20) received only ropivacaine. The primary outcomes studied were onset and duration of sensory and motor block. Secondary outcomes included duration of analgesia, total analgesic consumption in 24 h postoperatively and quality of block. ANOVA and Chi-square test were used to compare results on continuous measurements and categorical measurements, respectively. Results: Onset of sensory and motor block was faster in group 1 (13.5 ± 4.1 and 17.0 ± 4.1 min) and group 2 (15.6 ± 3.6 and 18.5 ± 3.7 min) as compared to group 3 (20.1 ± 5.3 and 24.9 ± 5.6 min; P < 0.001). Block duration was significantly longer in group 1 and group 2 than in group 3. Duration of analgesia was prolonged in group 1 and 2 (1218.0 ± 224.6 and 1128.0 ± 207.5 min, respectively) as compared to group 3 (768.0 ± 273.7 min; P < 0.001). Twenty-four hours analgesic consumption postoperatively was reduced in the two study groups. Conclusion: Both dexmedetomidine and dexamethasone when used as adjuvants to ropivacaine for SCBP block, block onset time, and prolong' block duration.

Background: Supraclavicular brachial plexus block (SCBPB) has gained popularity with the addition of various adjuncts to local anesthetics. This study aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided (USG) SCBPB. Materials and Methods: One hundred patients of either sex, belonging to the American Society of Anesthesiologists physical status I or II, aged between 15 and 65 years and scheduled for elective upper arm surgery under USG SCBPB were enrolled. Patients were randomly allocated into two groups (n = 50). Both groups received 16 ml (120 mg) 0.75% ropivacaine with 1 μg/kg dexmedetomidine diluted in 8 ml normal saline (NS) (Group Ropivacaine Dexmedetomidine [RD]) or with 8 ml NS only (Group R). The primary outcome measure was the duration of analgesia, whereas secondary outcome measures were onset and duration of sensory and motor block, quality of anesthesia, sedation score, hemodynamic changes, and side effects. Statistical analysis was performed using unpaired Student's t-test or nonparametric Mann–Whitney test and Chi-square test. Results: The duration of analgesia was significantly prolonged in Group RD (730.70 ± 51.62 min) compared to Group R (388.30 ± 41.66 min), (P < 0.0001). The onset time of sensory and motor block was significantly shorter in Group RD in comparison to Group R (P < 0.001). The duration of sensory and motor block was significantly prolonged in Group RD compared to Group R, (P < 0.0001). The quality of anesthesia was significantly better in Group RD (P < 0.05). Sedation scores were significantly higher in Group RD (P < 0.05). No significant hemodynamic changes and side effects were observed in both groups (P > 0.05). Conclusion: Dexmedetomidine provides the prolonged duration of analgesia along with faster onset as well as prolonged duration of both sensory and motor block without any significant hemodynamic changes and side effects.

ObjectiveThis prospective, double-blind, randomized study assessed (1) the associations between diaphragm compound muscle action potential (CMAP), hemidiaphragmatic excursion, and pulmonary function after supraclavicular brachial plexus block (SCBPB) and (2) diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength was evaluated.MethodsEighty-six patients were scheduled for the removal of hardware after healing of a right upper limb fracture distal to the shoulder who were randomly assigned in a 1:1 ratio to two groups: Group A (diaphragmatic excursion), or Group B (pulmonary function). Phrenic nerve conduction studies (PNCSs), M-mode ultrasonography of the diaphragm, and pulmonary function tests (PFTs) were performed before and 30 min after SCBPB. PNCSs were used to determine the latency and amplitude of diaphragm CMAP. Ultrasonography of the diaphragm was performed with patients in a supine position using a low-frequency probe over the subcostal space at the midclavicular line. The diaphragmatic excursion was measured during quiet breathing and deep breathing. Pulmonary function, i.e., forced vital capacity (FVC), predicted value of FVC, and forced expiratory flow in the first second (FEV1), was measured with spirometry. Receiver Operating Characteristic (ROC) curve analysis was used to assess the diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength.ResultsThere were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in diaphragmatic excursion during quiet breathing (r = 0.70, p < 0.01) and deep breathing (r = 0.63, p < 0.01) when expressed as a percentage of baseline values. There were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in FVC (r = 0.67, p < 0.01), FVC% (r = 0.67, p < 0.01), and FEV1 (r = 0.62, p < 0.01), when expressed as percentage of baseline values. The area under the ROC curve for FVC was 0.86. A decrease of >8.4% in FVC compared to pre-block predicted hemidiaphragmatic paralysis (determined by diaphragm CMAP) with sensitivity and specificity of 79.2 and 100%, respectively.ConclusionsThe relative reduction in diaphragm CMAP amplitude after SCBPB was correlated with relative reductions in diaphragmatic excursion and pulmonary function. FVC has potential as a useful diagnostic indicator of hemidiaphragmatic paralysis, evidenced by diaphragm CMAP, after SCBPB. These data establish diaphragm CMAP as a direct and objective index of diaphragmatic paralysis after SCBPB.