Ultrasound guided supraclavicular brachial plexus block with 0.25% bupivacaine and 0.25% bupivacaine with dexamethasone- A comparative study.

Background: Bupivacaine which has commonly been used has an advantage of being a Long-acting analgesic. Dexamethasone has been widely studied to have an effect on the action of local anesthetic by prolonging their action. Dex-amethasone also acts by blocking pain signal transmission and nerve block prolonging effects. Aim: ultrasound guided supraclavicular brachial plexus block with 0.25% bupivacaine and 0.25% bupivacaine with dexamethasone- a comparative study’ Method and materials: this is a prospective randomized comparative study done in department of Anesthesiology, SMS medical college Jaipur in 60 patients from February 2021 to February 2023. Participants will be re-cruited as patients undergoing upper limb surgery under Brachial Plexus Block Regional anaesthesia in General surgery and orthopedic surgery in-cluded this study. Informed consent was taken one day prior to surgery while doing pre-anesthetic evaluation from all patients. Patients were the randomly assigned in two groups (30 each) using computer generated se-quences. Group A- Patients receiving (30ml 0.25% bupivacaine + 2 ml of N/S) perineurally in the Brachial Plexus using supraclavicular approach. Group B - Patients receiving (30ml of 0.25% Bupivacaine+ 8mg (2ml) Dexamethasone) perineurally with same approach. Result: 30 casesstudied in Group A, 13 (43.3%) had Grade 1 ASA, 17 (56.7%) had Grade 2 ASA. Of 30 cases studied in Group B, 15 (50.0%) had Grade 1 ASA, 15 (50.0%) had Grade 2 ASA. (P-value>0.05). The mean ± SD of onset of sensory blockade in Group A and Group B was 22.90 ± 1.79 Mins and 19.85 ± 1.83 Mins respectively. The distribution of mean onset of motor blockade was significantly higher in Group A com-pared to Group B (P-value<0.001). The mean ± SD of time to rescue an-algesia in Group A and Group B was 5.35 ± 1.38 Hrs and 10.58 ± 0.92 Hrs respectively. The minimum – maximum time range in Group A and Group B was 4 – 9 Hrs and 9 – 13 Hrs respectively. The distribution of mean time to rescue analgesia was significantly higher in Group B com-pared to Group A (P-vale<0.001). Conclusion: The SBP, DBP and Heart Rate were Significantly on lower side in Bupivacaine with Dexamethasone group which was hemodynamically more stable. It is seen in this study that Single shot Supra-clavicular Brachial Plexus Block analgesia was of longer duration in Bu-pivacaine plus Dexamethasone group than plain Bupivacaine Group. There were statistically significant lower values of VAS PAIN score at various points in Bupivacaine plus Dexamethasone Group. Intraoperative and postoperative bradycardia or hypotension was not observed in any group, Postoperative nausea /vomiting were not observed in any group. Hence Dexamethasone added to Bupivacaine for single shot Brachial Plexus Blockade was efficient in prolonging duration of analgesia com-pared to Bupivacaine only with minimum or no side effects. [ABSTRACT FROM AUTHOR]