Brachial Plexus Blockade, Upper Limb Surgery
Conditions
Keywords
Brachial Plexus Blockade, Mangesuim sulphate, ultrasound, Dexamethasone, Dexmedetomidine
Brief summary
This study is to evaluate whether addition of dexmedetomidine, dexamethasone and magnesium sulfate as adjuvants to bupivacaine in supraclavicular Brachial Plexus Blockade (BPB) for pain management assessed by VAS score.
Detailed description
This is a randomized controlled study involving 105 participants divided into three groups to assess the efficacy of adding dexmedetomidine, dexamethasone, and magnesium sulfate as adjuvants to bupivacaine in supraclavicular brachial plexus blockade during upper limb surgeries. The primary outcome is the postoperative Visual Analog Scale (VAS) score. The secondary outcomes are assessment of onset and duration of the block, patient satisfaction, and adverse effects.
Interventions
PROCEDUREGroup A (DT): Dexmedetomidine group
The ultrasound probe is placed in the supraclavicular fossa in the transverse orientation parallel to the clavicle and aimed inferior toward the ipsilateral thorax. The brachial plexus and the subclavian artery are visualized. The first rib appears as a hyperechoic line with the lung pleura deeper to this bony border. Utilizing the in-plane approach, the needle is advanced from lateral to medial, aimed near the main neural cluster of the brachial plexus. After negative aspiration, local anesthetic, including 100 µg Dexmeditomidine and normal saline, with a total volume of 20 mL, is injected. Subsequently, smaller aliquots of local anesthetic are deposited near the surrounding satellite neural clusters.
PROCEDUREGroup B (MG): Magnesium group
The ultrasound probe is placed in the supraclavicular fossa in the transverse orientation parallel to the clavicle and aimed inferior toward the ipsilateral thorax. The brachial plexus and the subclavian artery are visualized. The first rib appears as a hyperechoic line with the lung pleura deeper to this bony border. Utilizing the in-plane approach, the needle is advanced from lateral to medial, aimed near the main neural cluster of the brachial plexus. After negative aspiration, local anesthetic, including 150 mg of magnesium sulfate and normal saline, with a total volume of 20 mL, is injected. Subsequently, smaller aliquots of local anesthetic are deposited near the surrounding satellite neural clusters.
PROCEDUREGroup C (DM): Dexamethasone group
The ultrasound probe is placed in the supraclavicular fossa in the transverse orientation parallel to the clavicle and aimed inferior toward the ipsilateral thorax. The brachial plexus and the subclavian artery are visualized. The first rib appears as a hyperechoic line with the lung pleura deeper to this bony border. Utilizing the in-plane approach, the needle is advanced from lateral to medial, aimed near the main neural cluster of the brachial plexus. After negative aspiration, local anesthetic, including 8 mg dexamethasone and normal saline, with a total volume of 20 mL, is injected. Subsequently, smaller aliquots of local anesthetic are deposited near the surrounding satellite neural clusters.
Sponsors
Al-Azhar University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) status of I and II * undergoing forearm surgeries
Exclusion criteria
* coagulopathies * Local skin lesions * Pregnancy * Has a history of significant neurological, psychiatric, or neuromuscular disorders * Patients refusing participation * BMI \> 40 * Patient with COPD. hypersensitivity or allergies to local anesthesia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| -Post operative Visual analogue scale VAS score | Over 24 hours post operative starting from transeferring the patient to the recovery area. | Assess post-operative VAS score at: T0 (after transferring to the recovery area), at T1: at two hours, T3: at four hours, T4: at six hours, T5: at eight hours, T6: at 10 hours, T7: at 12 hours, T8: at 16 hours, T9: at 20 hours, and T10 at 24 hours postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Onset of motor block | Complete motor block will be assessed every 5 min up to a maximum of 30 minutes | Time in minutes from completing the block up to the time when the patient is unable to overcome gravity relative to the contralateral arm. |
| Duration of the sensory block | Sensation will be assessed every 4 hours till return of normal sensation up to maximum 24 hours . | Complete return of the sensation in the blocked limb relative to the contralateral arm. |
| duration of the motor block | Motor power will be assessed every 4 hours till return of normal sensation up to maximum 24 hourswill be assessed every 4 hours till return of normal sensation up to maximum 24 hours | Complete return of the motor power in the blocked limb |
| Intraoperative mean arterial blood pressure | From positioning the patient to the block upto 90 minutes from removing the needle | Mean arterial blood pressure in mmHg will be assessed at T0: baseline before patient positing for the block, at T1: just after removing the needle, at T2: at 30 minutes, T3: at 60 Minutes , and T4: at 90 minutes intraoperatively |
| Onst of sensory block | Complete sensory block will be assessed every 5 min up to a maximum of 30 minutes | Time in minutes from completing the block to complete sensory loss to sensation of a cold cotton pad relative to the contralateral limb. |
| Post operative opioid consumption | Over 24 hours post operatively started form transferring the patient to the recovery area | Postoperative total doses of pethidine in milligrams will be counted. For patients with a VAS score of more than 4, pethidine 50mg will be given intramuscularly. |
| Post operative Nausea and vomiting | Over 24 hours post operative starting from transferring to the recovery area. | Nausea and vomiting attacks will be recorded over 24 hours postoperatively. |
| Postoperative transient neurologic symptoms | Over 48 hours post operative starting from transeferring to the recovery area. | Dysesthesia will be assessed every 12 hours postoperatively and reported |
| Intraoperative Pulse rate. | From positioning the patient to the block upto 90 minutes from removing the needle | pulse rate per minute will be assessed at T0: baseline before patient positing for the block, at T1: just after removing the needle, at T2: at 30 minutes, T3: at 60 Minutes, and T4: at 90 minutes intraoperatively |
Countries
Egypt
Outcome results
None listed