Ultrasound Guided Supraclavicular Brachial Plexus Block with 0.5% Bupivacaine and Additives: Case Series at Teaching Hospital Anuradhapura

Introduction: Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. Bupivacainei is a longacting regional anaesthetic, efficacy of which is altered with the co-administration of additives. Aim: Aim of the study was to assess the efficacy of supraclavicular block with 0.5% bupivacaine compared to co-administration of additives and the associated complications. Method: Following ethical clearance and informed written consent, over 5 months from July 2020, 152 adult patients at Teaching Hospital Anuradhapura Sri Lanka undergoing upper limb surgeries were divided into 4 groups & prospectively followed-up. All groups received 0.5% of Bupivacaine while additives 2% Lidocaine, 8.4% sodium bicarbonate & 8 mg Dexamethasone were added to the other 3 groups. Sensory and Motor block onset time, duration of post-block analgesia, acute and late complications and patient satisfaction were noted. Data was analysed using descriptive statistics & ANOVA, using SPSS V.25. Results: Successful surgical anesthesia was achieved in all patients with 0 cases of long-term neurological complications with 94% patient satisfaction. The motor & sensory block onset time & post block analgesia duration respectively for Lidocaine (9.74 min, 9.74 min & 7.07 h), Bicarbonate (12.89 min, 16.32 min & 12.09 h), dexamethasone (19.34 min, 17.24 min & 20.87 h) & Bupivacaine were (20.39 min, 18.42 min & 13.15 h). Conclusion: The differences between bupivacaine and lidocaine groups for sensory & motor block onset times & between Bupivacaine & dexamethasone groups for post-block analgesia duration were statistically significant (p < 0.001). Supraclavicular block has minimal associated complications & additives Lidocaine shortens the onset of anaesthesia and the duration of analgesia while dexamethasone prolongs the duration of analgesia significantly.