Supraclavicular Brachial Plexus Block During Upper Limb Surgeries
Status:
Not yet recruiting
Trial end date:
2023-05-01
Target enrollment:
Participant gender:
Summary
Comparative Study Between Ketamine-Bupivacaine Versus Bupivacaine With Intravenous Ketamine
Infusion In Supraclavicular Brachial Plexus Block During Upper limb Surgeries The techniques
of regional anesthesia have become very popular as they provide several advantages in
comparison with general anesthesia and systemic analgesia.
They provide perfect pain control, decreased complications and reduced post-anesthesia care
unit stay.
Regional anesthesia provides more patient safety and better outcomes, which leads to the fact
that ultrasound-guided regional anesthesia became more popular.
Ultrasound provides clinicians with real-time images which are useful for better
identification of the anatomical structures, safe needle placement and adequate local
anesthetic spread.
Brachial plexus blocks are commonly achieved via an interscalene, supraclavicular,
infraclavicular or axillary approach.
The supraclavicular level is an ideal site to achieve anesthesia of the entire upper
extremity just distal to the shoulder as the plexus remains relatively tightly packed at this
level, resulting in a rapid and high-quality block. For this reason, the supraclavicular
block is often called the ''spinal of the arm'' Using the local anesthetics alone for
supraclavicular brachial plexus block provide good operative conditions but have the
disadvantage of shorter duration of postoperative analgesia. Various adjuvants such as
opioids, dexmedetomidine, dexamethasone, midazolam, ketamine, etc., were added to local
anesthetics in brachial plexus block to achieve quick and prolonged block.
Ketamine is a noncompetitive antagonist of the N-methyl-D aspartate receptor(NMDAR).
It is used as a premedication, and for sedation, induction and maintenance of general
anesthesia.
Local anesthetic and analgesic properties have been reported for ketamine. Intravenous
administration of low-dose ketamine decreases postoperative opioid use and improves
analgesia.
Ketamine has been added to bupivacaine to prolong the duration of regional anesthesia and
postoperative analgesia.