Comparative study between Ketamine and dexamethasone added to bupivacaine in ultrasound guided infra clavicular brachial plexus block for upper limb surgeries

Abstract

Background the aim of this study is to compare between ketamine and dexamethasone when added to bupivacaine in ultrasound guided infraclavicular brachial plexus block for upper limb surgeries. Methods: The patients were randomly allocated to two groups, 25 patients each: Group K (ketamine group) Patient received 30 ml of 0.375% bupivacaine plus 0.5 mg/kg ketamine in 2 ml saline Group D (dexamethasone group) Patient received 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml. Results: Onset time of sensory and motor blocks was significantly decreased in dexamethasone group in comparison with the ketamine group. The visual analogue scale was significantly lower in patients who received dexamethasone versus patients who received local anesthetics and ketamine. The duration of analgesia and resolution of motor block were significantly prolonged in dexamethasone group as compared to ketamine group. Postoperative analgesic consumption was reduced significantly in dexamethasone group as compared with ketamine group. Conclusion: The addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post-operative analgesia, lower analgesic consumption and lower incidence of complications.

Ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy. A randomized controlled trial

“…It was previously demonstrated that ketamine has a local anesthetic-like action through interaction with the rat myocyte's sodium channel. Ketamine also blocks the N-methyl-D-aspartate receptors incorporated in the pain pathway [8][9][10][11][12][13][14]. The aforementioned effects could explain the trial of ketamine as an adjuvant during fascial plane blocks.…”

“…Ketamine, an intravenous anesthetic, has been used as an adjuvant to LA during combined sciatic-femoral nerve block [8], axillary block [9], infraclavicular brachial plexus block [10], thoracic paravertebral block [11], Modified Pectoral Block [12], interscalene brachial plexus block [13], and femoral nerve block [14]. However, the ketamine results were controversial, varying from enhancing the LA's onset and prolonged duration to not improving the onset or duration of the sensory block.…”