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Evaluation of Fentanyl as an Adjuvant in Ultrasound Guided Supraclavicular Brachial Plexus Block

Rajashekar R. Mudaraddi* , Rajashekar R. Mudaraddi* , Ashwin Kumar Kanthi**

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Indian Journal of Anesthesia and Analgesia 4(1):p 123-128, January - March 2017. | DOI: DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4117.20

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Abstract

 Background & Objectives: Supraclavicular brachial plexus blocks have been performed effectively using local anaesthetic agents alone for upper limb surgeries. The Primary objective of this study is to determine whether the addition of fentanyl to a supraclavicular brachial plexus block improves the success rate, block time, duration and quality of postoperative analgesia. Secondary objective is can fentanyl be recommended as a safe adjuvant to local anaesthetic agents for peripheral blocks. Design & Methods: The study was conducted on ASA I­III patients who were randomly divided into Group I (Control) and Group II (Study). Patients in the control group received 20 ml 0.5% bupivacaine, 10 ml 2% lidocaine and 2 ml normal saline. The study group received 20 ml 0.5% bupivacaine, 10 ml 2% lidocaine and 2 ml fentanyl (100 g). Onset times for sensory and motor block were recorded. Post­operatively patients were followed over a 24 h period at 2hr interval for any breakthrough pain, and the intensity of pain was determined using Verbal Rating Score (VRS) system. Results: Fifty patients were studied with 25 in each group. The overall mean Verbal Rating Score for immediate postoperative pain in the fentanyl group was 2.6 compared to that of the control group which was 3.8 (p<0.001). 24 h post­operatively at 2hr intervals, the VRS ranged between 1 and 8; the mean VRS in control group was 5.7 while it was 3.8 in the study group (p<0.001). There was also a significant reduction in the incidence of breakthrough pain in the fentanyl group (p<0.0001) at the end of 24 hrs. Conclusions: The study found that the addition of 100 g fentanyl in supraclavicular brachial plexus block prolongs the duration of analgesia without any side effects. Fentanyl may be used as a safe adjuvant for supraclavicular brachial plexus blocks to improve the quality of analgesia.

Keywords: Fentanyl; Brachial Block; Ultrasound.

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DOI: DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4117.20

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