EVALUATION OF THE EFFICACY OF FENTANYL AS AN ADJUVANT TO THE MIXTURE OF 0.5% BUPIVACAINE AND 2% LIGNOCAINE IN BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

Dr. Chiranjeevi Saraswathi; Dr. Jalla Shireesha Kumari; Dr. P. Sreevani; Dr. K.V. Srinivasan

Volume : X, Issue : II, February - 2020

EVALUATION OF THE EFFICACY OF FENTANYL AS AN ADJUVANT TO THE MIXTURE OF 0.5% BUPIVACAINE AND 2% LIGNOCAINE IN BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

Dr. Chiranjeevi Saraswathi, Dr. Jalla Shireesha Kumari, Dr. P. Sreevani, Dr. K. V. Srinivasan

Abstract :

Regional blocks are advantageous over general anaesthesia as they avoid morbidity and complications associated with general anaesthesia.1In addition, they offer postoperative analgesia and cost–effectiveness. Hence, they are usual choice of anaesthesia for upper limb surgeries. Supraclavicular approach of achial plexus block is one of the regional block techniques that is safer and popular among various achial plexus block techniques. Supraclavicular approach achial plexus block is effective in terms of cost and performance, margin of safety, along with good postoperative analgesia. Lignocaine and bupivacaine are the most commonly used local anaesthetics of which lignocaine has faster onset and shorter duration of action whereas bupivacaine has slower onset and longer duration of action. Adding these two drugs make a mixture, which has shorter time of onset and longer duration of action. Adjuvants like fentanyl, dexamethasone, neostigmine and clonidine are usually added to local anaesthetics to improve the quality and duration of anaesthesia. (2) Fentanyl is a potent synthetic opioid compound with rapid onset and shorter duration of action with strong agonistic activity at Mu–receptors with high therapeutic index which makes it very safe surgical analgesic. Most of the studies proved the benefit of addition of fentanyl to the local anaesthetics in regional blocks in prolonging the sensory and motor blockade and decreasing the need for rescue analgesia following the surgery. (3,4,5) But some studies show no additional benefit. (6) Hence this study has been taken up to evaluate the usefulness of addition of fentanyl to the local anaesthetic mixture considering the onset and duration of sensory and motor blockade along with the need for rescue analgesics postoperatively. A randomized single blinded study was taken up in two groups of thirty patients each. The mean age of patients was 38.65 years and 40.23 years in group C (lignocaine and bupivacaine) and group F (lignocaine, bupivacaine and Fentanyl) respectively. The two groups were comparable with respect to age. The mean times of onset of sensory and motor blockade in Group C (Lignocaine and Bupivacaine) was 8.8 ± 0.81 minutes and 13.2± 1.42 minutes and in Group F (Lignocaine, Bupivacaine and Fentanyl) 6.8 ± 1.01 minutes and 11.2 ± 1.51 minutes which are statistically significant. The mean durations of sensory and motor blockade in Group C (Lignocaine and Bupivacaine) was 597.92± 41.71 minutes and 483.1± 34.64 minutes and in Group F (Lignocaine, Bupivacaine and Fentanyl) 823.54±59.52 min and 627.8 ± 52.12 minutes which are statistically significant. The mean number of rescue analgesics were significantly lesser in Fentanyl group compared to the control group in this study. Fentanyl group required lesser number of analgesics compared to Control group and control group required more frequent (3 to 4) rescue analgesics compared to Fentanyl group. There were no significant changes in hemodynamic response between Group C (Lignocaine, Bupivacaine) and Group F (Lignocaine, Bupivacaine and Fentanyl) groups. There was no significant difference between the oxygen saturation between group C and Group F