The Efficacy of Different Combination Drugs in Ultrasound-guided Axillary Brachial Plexus Nerve Blockade

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Kunchana Wiseskarn

Abstract

Background: The axillary brachial plexus block (ABPB) is a popular technique for hand, forearm and elbow surgery, relatively simple to perform, easy landmark and may be associated with a lower risk of complications. Ultrasound-guided peripheral nerve block causes a safe and reliable block. But pure local anesthetic drugs are not covered postoperative period. Objectives: To assess the duration of block and analgesic effect of adding either dexamethasone or morphine to 0.25% bupivacaine. Methods: This is a prospective randomized double-blinded controlled trial. Patients undergoing surgery of elbow, forearm or hand were enrolled and divided into 3 groups with 21 patients in each group. All patients were received ABPB as an anesthetic technique. In control group (group C), the combination of 0.5% bupivacaine 15 ml and 2% plain lidocaine 15 ml with adrenaline 150 mcg were used. Dexamethasone 4 mg and morphine 5 mg were added to the control group drug in group D and group M, respectively. Results: The duration of motor (658.4±225.6 minutes) and sensory blockade (790.1±305.3 minutes) in group D were significantly longest among other groups (p 0.01). Total opioid consumption was significantly lower in group D than in group C (p 0.01). Time to first analgesic request was similar among groups. The first numerical rating scale (NRS) report and at 24 hours were significantly lowest in group D.Conclusion: Adding dexamethasone 4 mg into 0.25% bupivacaine prolonged duration of motor and sensory blockade, decreased NRS and postoperative opioid consumption.

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