Comparison of effects of 0.5 % levobupivacaine with buprenorphine and nalbuphine in ultrasound-guided supraclavicular brachial plexus block- A Randomised Control Trial

TL;DR

This study compares buprenorphine and nalbuphine as additives to a local anesthetic for brachial plexus block, finding that buprenorphine improves the speed and duration of anesthesia.

Contribution

The study demonstrates that buprenorphine improves onset and duration of anesthesia compared to nalbuphine when added to 0.5% levobupivacaine.

Findings

Buprenorphine shortened the onset of sensorimotor blockade compared to nalbuphine and plain levobupivacaine.

Buprenorphine prolonged the duration of sensorimotor blockade significantly.

Buprenorphine delayed the need for rescue analgesia after 12 hours.

Abstract

The brachial plexus block is one of the most commonly used anaesthesia techniques for upper limb surgeries. The supraclavicular brachial plexus block (SCBB) has been a frequently performed technique because it provides excellent quality of blockade, faster onset, and dense blockade. Different adjuvants and local anaesthetics are used to improve the onset and quality of the blockade. In our study, the local anaesthetic used was 0.5% levobupivacaine, and the adjuvants used were buprenorphine and nalbuphine.

Our study, a randomised, prospective double-blinded investigation, was conducted on 60 patients scheduled for elective upper limb orthopaedic surgeries. We performed the Supraclavicular brachial plexus block with 25 ml of 0.5% levobupivacaine plain (Group L) or with buprenorphine (Group LB) or with nalbuphine (Group LN) as adjuvants. We recorded the onset, duration of blockade (motor and sensory), sedation score, and time for rescue analgesia.

The onset of sensorimotor blockade was notably faster in Group LB than in Group LN or Group L. The sensorimotor blockade duration was significantly prolonged in Group LB compared to LN and L. Group LB also had a delayed time after 12 hrs for rescue analgesia compared to the other two groups.

Buprenorphine as an adjuvant to 0.5% levobupivacaine in ultrasound-guided supraclavicular brachial plexus block significantly shortens the onset of sensorimotor blockade and enhances the duration of blockade when compared to nalbuphine. Both the adjuvants delayed the time for request of rescue analgesia compared to plain levobupivacaine.

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