The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block

Abstract

Aims:The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block.Settings and Design:This is a prospective randomized controlled observer-blinded study.Subjects and Methods:This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request.Statistical Analysis Used:The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant.Results:Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E.Conclusions:In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.

Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study

“…Many additives are used to improve the quality of analgesics, but the results are either uncertain or associated with undesirable adverse effects [1]. This study revealed that the addition of midazolam to bupivacaine during ultrasound-guided supraclavicular BPB provided better neurological and analgesic qualities than the addition of neostigmine.…”

“…It prevents the undesirable effects of using general anesthesia and upper airway instruments [1]. Moreover, it reduces the duration of hospitalization and costs, and provides complete muscle relaxation [1, 2]. The ultrasound-guided technique requires a lower anesthetic volume to provide an efficient block and decreases the risk associated with intravascular injections and trauma to the surrounding tissues [3].…”

“…Several adjuvants have been co-administered with bupivacaine, but the results have been either unconvincing or associated with untoward complications [4]. Several researchers have attempted to combine bupivacaine with other anesthetics such as ketamine [5], clonidine [6], midazolam [1], and neostigmine [7] with various success rates.…”

“…It prevents the undesirable effects of using general anesthesia and upper airway instruments [1]. Moreover, it reduces the duration of hospitalization and costs, and provides complete muscle relaxation [1, 2].…”

“…Midazolam, a water-soluble benzodiazepine, reduces pain perception [1] via postsynaptic gamma-aminobutyric acid (GABA A ) receptors, opioid receptors, and benzodiazepine receptors in the spinal cord. GABA A receptor is a chloride ionophore that, when activated, decreases neural excitability by stabilizing the membrane potential near the resting potential [8].…”