Efficacy of adding ketamine, dexamethasone, and epinephrine with bupivacaine in ultrasound-guided supraclavicular brachial plexus block

Background Supraclavicular brachial plexus block is an effective anesthesia for upper limb surgery as it provides anesthesia and postoperative analgesia. Various adjuvants were added to local anesthetics to achieve dense and prolonged blocks.Objective The aim of this study is to compare the effect of adding ketamine, dexamethasone, or epinephrine to bupivacaine on onset time, duration of sensory and motor block, intraoperative and postoperative hemodynamic stability, patient satisfaction, and any adverse effects.Patients and methods This study was carried out on four groups of patients. Patients were anaesthetized by ultrasound-guided supraclavicular brachial plexus block; group B was anaesthetized by an injection of 20 ml bupivacaine (0.5%) plus 2 ml of saline; group K received 20 ml bupivacaine (0.5%) and ketamine 1.5 mg/kg; group D received 20 ml bupivacaine (0.5%) and dexamethasone 8 mg; and group E received 20 ml bupivacaine and epinephrine (5 μg/ml). Patients were assessed for the onset and duration of sensory and motor block. Intraoperative and postoperative analgesia were assessed by visual analog scale, and intraoperative and postoperative sedation was assessed according to Culebras scale.Results Group D showed a shorter onset of sensory and motor blocks compared with the other groups. Group D showed statistically significant longer duration of analgesia compared with the other groups. There was significant decrease in postoperative analgesic requirement in group D during the first 24 h postoperatively compared with the other groups.Conclusion Dexamethasone with bupivacaine in supraclavicular brachial plexus block has a longer duration of sensory and motor blocks and less requirement of rescue analgesia in the first 24 h postoperatively.