Comparison of Local Anesthetic Mixtures with Tramadol or Fentanyl for Axillary Plexus Block in Orthopaedic
Upper Extremity Surgery

Geze, Şükran; Ulusoy, Hülya; Ertürk, Engin; Çekiç, Bahanur; Arduc, Cevahir

doi:10.29333/ejgm/82475

Cited by 10 publications

(16 citation statements)

References 18 publications

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“…Karakaya D et al (11) observed that 100 mcg/kg fentanyl added in axillary brachial plexus produced no difference in block characteristics of bupivacaine 0.25% but doubled postoperative analgesia. Supportive observation in increase in duration of sensory and motor block with postoperative analgesia has also been observed in studies by Geze et al, (20) Madhusudan et al, (4) Sindjelic et al (21) and Chavan SG et al (12) The extended anaesthetic and analgesic effect as observed in Group RF could be attributed to fentanyl directly acting on the peripheral nervous system. The existence of endogenous and exogenous opioid receptors in the peripheral nervous system and the initiation of anti-nociceptive action by the activation of such receptors offer the possibility of extended analgesic action.…”

Section: Diagram 2: Trend In Mean Arterial Pressuresupporting

confidence: 49%

Comparison of the Effects of Fentanyl and Dexmedetomidine in Supraclavicular Brachial Plexus Block Achieved With Ropivacaine

Cham¹,

Sangawar²,

Ramtani³

et al. 2015

jemds

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BACKGROUND & OBJECTIVES:Supraclavicular block of brachial plexus provides complete and reliable anaesthesia for upper limb surgeries. Ropivacaine, is an affective local anaesthetic in for brachial plexus anaesthesia. It is a potent blocker of Aδ and C fibres, rendering good sensory effect but less motor blockade. We evaluated the anaesthetic quality and length of analgesia with the addition of either fentanyl or dexmedetomidine to ropivacaine for Supraclavicular brachial plexus block. METHODS: In a prospective clinical trial, 90 patients were randomly allocated to either receive 30 ml ropivacaine 0.5% (Group R), 30 ml ropivacaine 0.5% with fentanyl 50 mcg (Group RF) or 30 ml ropivacaine 0.5% with dexmedetomedine 50 mcg (Group RD) in Supraclavicular brachial plexus. The characteristics for anaesthesia and analgesia were assessed for the three groups. OBSERVATIONS: Demographic profile was comparable in the groups. The onset of analgesia and time to complete analgesia was enhanced in Group RD and Group RF compared to Group R. Prolongation of sensory blockade and motor blockade with extended duration of postoperative analgesia was observed in Group RD and Group RF compared to Group R. There were minimum haemodynamic disturbances and side-effects in any group except for Grade 3 sedation score which was frequently noted in patients receiving dexmedetomidine as adjunct. RESULTS: Compared to the use of ropivacaine 0.5%, 30 ml alone for supraclavicular brachial plexus block, the addition of 50 mcg fentanyl or 50 mcg dexmedetomidine to ropivacaine enhanced onset of block and also increased duration of surgical anaesthesia with prolongation of post-operative analgesia. Furthermore blockade characteristics improved better with addition of dexmedetomodine than fentanyl without increasing incidence of unwanted side-effects.

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Section: Diagram 2: Trend In Mean Arterial Pressuresupporting

confidence: 49%

Comparison of the Effects of Fentanyl and Dexmedetomidine in Supraclavicular Brachial Plexus Block Achieved With Ropivacaine

Cham¹,

Sangawar²,

Ramtani³

et al. 2015

jemds

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“…The studies included in this review originated from eight countries, i.e., Austria [ 31 ], France [ 29 ], Germany [ 28 ], India [ 16 , 27 ], Italy [ 22 , 30 ], Pakistan [ 17 ], Turkey [ 18 , 20 , 21 , 25 , 26 ], and Tunisia [ 19 , 24 ]. The patients had undergone various types of surgery, including repair of an arteriovenous fistula [ 25 ], carpal tunnel release [ 29 , 30 ], shoulder arthroplasty [ 22 ], and shoulder or upper extremity surgery [ 16 – 21 , 23 , 24 , 26 – 28 , 31 ]. There were no studies using an infraclavicular approach for BPB.…”

Section: Resultsmentioning

confidence: 99%

“…There were no studies using an infraclavicular approach for BPB. The details of BPB were recorded according to type of approach (axillary [ 17 , 18 , 20 , 21 , 24 – 26 , 28 – 31 ], interscalene [ 22 ], supraclavicular [ 16 , 19 , 23 , 27 ]), the technique used for nerve guidance (landmark [ 16 , 17 , 23 , 27 , 28 ], nerve stimulator [ 18 , 20 – 22 , 24 – 26 , 29 – 31 ] or ultrasound guidance [ 19 ]), type of LA (bupivacaine [ 16 , 27 ], levobupivacaine [ 20 , 22 ], lidocaine [ 19 , 24 ], mepivacaine [ 29 , 31 ], prilocaine [ 28 ], ropivacaine [ 18 , 23 , 25 , 26 , 30 ], or a mixture of LA agents [ 17 , 21 ]), dose of tramadol (50 mg [ 18 , 23 ], 100 mg, or 1.5 mg/kg [ 16 , 17 , 19 – 22 , 24 – 31 ]), and the definitions of sensory bl...…”

Section: Resultsmentioning

confidence: 99%

Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis

Shin

Jang

et al. 2017

PLoS ONE

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BackgroundTramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA) effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB). This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery.MethodsWe searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs) that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software.ResultsWe identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004), motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003), and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001) compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001) and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010). In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05) but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies.ConclusionsIn upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and shorten the time to onset of sensory and motor blocks without altering adverse effects.

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“…An ideal drug should have a fast sensory onset, differential offset, with an earlier offset of motor than sensory blockade, enabling early ambulation/movements with prolonged analgesia. Several combinations of LAs and adjuvants such as tramadol,[ 1 2 ] sufentanyl,[ 2 ] clonidine,[ 2 ] and fentanyl[ 3 ] have been employed in the search for near ideal agent, which remains elusive. Currently, levobupivacaine (S(−)-enantiomer of bupivacaine) with favorable clinical profile and lesser cardiotoxicity when compared with racemic bupivacaine[ 4 5 ] is being favored LA for regional block.…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A randomized double-blind prospective study

Kaur

Singh

Rani

et al. 2015

J Anaesthesiol Clin Pharmacol

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Background and Aims:Regional anesthesia is a recommended technique for upper and lower limb surgeries with better postoperative profile. In this, randomized, double-blind study, we evaluated the effectiveness of the addition of dexmedetomidine to varying concentration of levobupivacaine for supra clavicular brachial plexus block.Material and Methods:After obtaining ethical Committee approval, a double-blind, randomized prospective clinical study was conducted on 90 American Society of Anesthesiologist Grade I and II patients in the age group of 18-55 years, divided randomly into two groups: Group A received 40 ml of solution containing 30 ml 0.5% levobupivacaine and 10 ml 1% lignocaine and group B received 40 ml of solution containing 30 ml 0.25% levobupivacaine and 10 ml 1% lignocaine with dexmedetomidine 1 microg/kg for supraclavicular brachial plexus block. Besides effectiveness, other parameters observed were: duration of sensory blockade; onset and duration of motor blockade; duration of postoperative analgesia; and patient satisfaction score.Results:Onset of sensory and motor blockade was 7.6 ± 1.006 min and 8.3 ± 0.877 min in group A, while it was 6.96 ± 1.077 min an 7.6 ± 1.1 min in group B, respectively. The difference was statistically significant (P < 0.05). Duration of sensory block was 8.5 ± 0.77 h in group A and 8.5 ± 0.98 in group B (P > 0.05). Duration of motor block was 8.45 ± 0.75 h in group A and 5.6 ± 0.98 in group B (P < 0.05). Duration of analgesia was 8.5 ± 0.77 h in group A and 9.2 ± 1.05 in group B (P < 0.05).Conclusion:Addition of 1 microg/kg dexmedetomidine to 0.25% levobupivacaine for supraclaviclar plexus block shortens sensory, motor block onset time and motor block durations, extends sensory block, and analgesia durations. Reduction in total levobupivacaine dose also increases the safety margin of the block.

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Comparison of Local Anesthetic Mixtures with Tramadol or Fentanyl for Axillary Plexus Block in Orthopaedic Upper Extremity Surgery

Cited by 10 publications

References 18 publications

Comparison of the Effects of Fentanyl and Dexmedetomidine in Supraclavicular Brachial Plexus Block Achieved With Ropivacaine

Comparison of the Effects of Fentanyl and Dexmedetomidine in Supraclavicular Brachial Plexus Block Achieved With Ropivacaine

Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis

Effect of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A randomized double-blind prospective study

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