Sleep Quality and Patient Satisfaction after Using Ketamine and Local Anesthetic for Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Extremity Surgery

Main Article Content

Pavit Sappayanon


Background: The use of supraclavicular brachial plexus block is the effective and popular anesthetic technique in operations for upper extremity. Ketamine has been found to improve the analgesic effects of local anesthetic drugs and increasing sleep efficiency. Objective: aims to assess the sleep quality and patient satisfaction after using ketamine and local anesthetic for supraclavicular brachial plexus block in patients who underwent upper extremity surgery. Methods: This study was a double-blinded randomized controlled trial. Fifty two patients undergoing upper extremity surgery using the supraclavicular brachial plexus block technique were randomly assigned into 2 groups of 26 patients each. All patients received 10 ml of 0.5% bupivacaine and 13 ml of 2% lidocaine with adrenaline (1:200,000) for supraclavicular brachial plexus block. Ketamine 0.5 mg/kg plus normal saline up to 2 ml and Normal saline 2 ml were added to local anesthetics in group K and group C, respectively. The outcome measures included sleep quality score by using consensus sleep diary and satisfaction score. Results: There was no significant difference among group K and group C in the sleep quality score (3.92 vs 3.46) mean difference 0.46 [-0.02, 0.94; p=0.062] and satisfaction score between group K and C (4.48 vs 4.42), mean difference 0.06 [-0.029, 0.40; p=0.743] Conclusion:Adding ketamine to the bupivacaine-lidocaine mixture in supraclavicular brachial plexus block for patients undergoing upper extremity surgery could not improve the sleep quality and patient satisfaction.

Article Details

Original articles


1. Abdallah FW, Brull R. Facilitatory effects of perineural
dexmedetomidine on neuraxial and peripheral nerve block:
a systematic review and meta-analysis. Br J Anaesth
2. Mohamed Z, El-Mourad MB, Yousef AA, Fetouh NH. The
effect of adding ketamine or midazolam to bupivacaine for
ultrasound-guided supraclavicular brachial plexus block for
upper extremity surgeries. Med J Cairo Univ 2018;86:2633-8.
3. Golwala MP, Swadia VN, Dhimar AA, Sridhar NV. Pain relief
by dexamethasone as an adjuvant to local anaesthetics in
supraclavicular brachial plexus block. J Anaesthesiol Clin
Pharmacol 2009;25:285-8.
4. Biradar P, Kaimar P, Gopalakrishna K. Effect of dexamethasone
added to lidocaine in supraclavicular brachial plexus block:
A prospective, randomised, double-blind study. Indian J
Anaesth 2013;57:180-4.
5. Safavi M, Khazaei M, Lashgarinia M, Naghibi K, Honarmand A.
Effect of ketamine as an adjuvant in ultrasound-guided
supraclavicular brachial plexus block: A double-blind
randomized clinical trial study. Adv Biomed Res 2014;3:232.
6. Tverskoy M, Oren M, Vaskovich M, Dashkovsky I, Kissin I.
Ketamine enhances local anesthetic and analgesic effects
of bupivacaine by peripheral mechanism: a study in
postoperative patients. Neurosci Lett 1996;215:5-8.
7. Lee I, Kim W, Kong M, et al. No enhancement of sensory and
motor blockade by ketamine added to ropivacaine interscalene
brachial plexus blockade. Acta Anaesthesiol Scand 2002;
8. Loix S, De Kock M, Henin P. The anti-inflammatory effects of
ketamine: state of the art. Acta Anaesthesiol Belg 2011;62:
9. Tajika T, Kuboi T, Endo F, et al. Association between upper
extremity dysfunction and sleep disturbance in an elderly
general population. SAGE Open Med 2020;8.
10. Peters RM, Menendez ME, Mellema JJ, Ring D, Vranceanu
A-M. Sleep disturbance and upper-extremity disability. Arch
Bone Jt Surg 2016;4:35-40.
11. Zhuo C, Tian H, Li G, et al. Effects of ketamine on circadian
rhythm and synaptic homeostasis in patients with treatmentresistant depression: A protocol for mechanistic studies of
its rapid and sustained antidepressant actions in humans.
Brain and Behavior 2019;9:e01423.
12. Duncan WC, Ballard ED, Zarate CA. Ketamine-induced
glutamatergic mechanisms of sleep and wakefulness:
insights for developing novel treatments for disturbed sleep
and mood. Handb Exp Pharmacol 2019;253:337-58.
13. Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus
sleep diary: standardizing prospective sleep self-monitoring.
Sleep 2012 ;35:287-302.
14. Royse CF, Newman S, Chung F, et al. Development and
feasibility of a scale to assess postoperative recovery: The
post-operative quality recovery scale. Anesthesiology
15. Hashim RM, Hassan RM. The efficacy of adjuvants to
bupivacaine in ultrasound-guided supraclavicular block:
a comparative study between dexmedetomidine, ketamine,
and fentanyl. Ain-Shams J Anesthesiol 2019;11:19.