Key result
Ketamine added to bupivacaine hastens sensory block onset and prolongs postoperative analgesia.
Why the study?
Despite advances in anesthesia and painkiller pharmacology, many patients continue to experience severe postoperative pain after surgery.
Does the addition of ketamine to bupivacaine supraclavicular brachial plexus block improve block onset and postoperative analgesia in patients undergoing upper limb surgeries?
RCT (n=150)
Double-blind
Yes
Does the addition of ketamine to bupivacaine supraclavicular brachial plexus block improve block onset and postoperative analgesia in patients undergoing upper limb surgeries?
Adding ketamine to bupivacaine for supraclavicular brachial plexus block improves block onset and prolongs postoperative analgesia in upper limb surgeries.
Supports faster supraclavicular block onset for upper limb surgery; extends RCT evidence for ketamine as bupivacaine adjunct.
Background: many of the surgical procedures are done daily all over the world. Patients get benefit from the amazing advances in both surgical and anesthesia techniques. However, despite the progress in understanding the physiology of pain and the pharmaceutical properties of painkillers, many patients are still suffering from severe postoperative pain after surgery. Objective: The aim of the current study was to determine the effect of the addition of 25 µg/kg body weight ketamine to 0.5% bupivacaine supra-clavicular brachial plexus block on quality of block, the time of onset and postoperative analgesia time. Patients and Methods: it is a prospective double blinded controlled study that was carried out on 150 patients ASA I – II, aged 18-50 years with different upper limb surgeries of the forearm and the hand in Assiut and Al-Azhar University Hospitals. Results: ketamine was more effective with a mean complete sensory block onset of 11.93±2.95 minute in the ketamine group compared to12.60±3.00 minutes in the control groups. The study also showed that ketamine hastened the onset of complete motor block, with a mean complete motor block onset of 17.33±3.79 minute in the ketamine group compared to 19.67±4.45 minutes in the control group. As regard analgesia duration, the present study showed that ketamine group prolonged the analgesia duration. Conclusion: It could be concluded that addition of (25 µg/kg) ketamine to bupivacaine improves onset of the block, postoperative pain-free time (VAS) and reduces the consumption of postoperative analgesics in patients undergoing different upper limb surgeries of the forearm and the hand.
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El-Soudy et al. (2019) conducted an RCT in Upper limb surgeries of the forearm and the hand (n=150). Ketamine added to 0.5% bupivacaine vs. 0.5% bupivacaine alone was evaluated on Complete sensory block onset time (minutes). Adding 25 µg/kg ketamine to bupivacaine for supraclavicular brachial plexus block hastened complete sensory block onset (11.93 vs 12.60 minutes) and prolonged postoperative analgesia.
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