Introduction: Ultrasonography (USG) guided supraclavicular block is an excellent choice for upper limb surgeries. It not only allows smaller volumes of local anaesthetic usage but also provides optimal tourniquet coverage. Ropivacaine is structurally related to bupivacaine with reduced potential for toxicity and improved sensory and motor blocking profiles. Nalbuphine acquired a significant place in pain control but its efficacy as a local anaesthetic adjuvant is yet to be proved in peripheral nerve blockades. Aim: To evaluate the efficacy of adding nalbuphine to ropivacaine in supraclavicular brachial plexus blockade and to assess the quality of block for patients undergoing ambulatory forearm and hand surgeries. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) grade 1 and 2 patients were randomised into two groups of 35 each. Group A (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of nalbuphine (10 mg) and Group B (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of normal saline. The parameters observed were duration of analgesia, onset of sensory and motor blockade, duration of motor blockade and haemodynamic changes during the procedure. Categorical variables were analysed using the Pearson’s Chi‑square test. Continuous variables were analysed using the independent sample t‑test and p<0.05 was considered as statistically significant. Results: The onset of sensory and motor blockades were faster in the nalbuphine group compared to the control group (p<0.001). The duration of sensory and motor blockades was similarly longer in nalbuphine group (p<0.001). Also, the mean duration of analgesia was significantly longer with nalbuphine group (p<0.001). Conclusion: Nalbuphine significantly prolonged the duration of analgesia and duration of block while accelerating the onset of blockade thereby improving the overall quality of blockade.

Introduction: Brachial plexus blockade at the supraclavicular level delivers an excellent regional anaesthetic technique with unmatched effectiveness for upper limb surgeries. Levobupivacaine, a safer alternative to the commonly used bupivacaine for regional anaesthesia and addition of α2-agonists like dexmedetomidine further improves the quality of regional anaesthesia. Aim: To evaluate the efficacy of levobupivacaine in combination with dexmedetomidine for supraclavicular brachial plexus block. Materials and Methods: This randomised controlled study enrolled 50 American Society of Anaesthesiologist (ASA) grade I and II patients aged between 18-60 years posted for elective upper limb surgeries. Randomisation was done and the patients were divided into two groups with 25 each, to receive either 39 mL of 0.5% levobupivacaine and 100 μgs (1 mL) of dexmedetomidine in group LD (Levobupivacaine with Dexmedetomidine) and 39 mL of 0.5% levobupivacaine and 1 mL of normal saline in group LS (Levobupivacaine with Saline). The onset and duration of sensory and motor blockade along with duration of analgesia were observed. All Quantitative data were compared and analysed using student’s unpaired t test while qualitative data were analysed using Chi-square test. A p-value of less than 0.05 was considered to be statistically significant. Results: The onset of sensory and motor blockade in group LD was significantly faster when compared to group LS (p<0.001). group LD had a longer mean duration of sensory and motor blockade along with duration of analgesia when compared to group LS (p<0.001). There was a better hemodynamic stability in group LD when compared to group LS. Conclusion: Dexmedetomidine added to levobupivacaine provides significantly shorter onset times, greatly prolongs the duration of sensory and motor blockade along with duration of analgesia without any systemic side effects.

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Introduction: The use of Ultrasound (USG) for needle precision aids in reduction of local anaesthetic volume needed for peripheral nerve blockade. Conventional dosages of 30 to 40 mL of local anaesthetic mixture have been used in peripheral nerve blockades but using a lesser volume will reduce the incidence of local anaesthesia associated systemic toxicity. Aim: To assess the efficacy of two different doses 20 mL and 25 mL of Bupivacaine in USG guided axillary plexus block. Materials and Methods: Sixty patients requiring forearm and hand surgeries were randomised into two groups. Group A received low volume (20 mL of 0.375% bupivacaine) and group B received intermediate volume (25 mL of 0.375% bupivacaine). The quality of anaesthesia in regards to sensory and motor blockade, duration of analgesia, haemodynamic variability and complications were evaluated. Successful block was defined by Vester Anderson’s criteria. Duration of analgesia was measured using Visual Analogue Scale (VAS). Statistical comparison of all continuous variables were assessed utilising Student’s t-test and Mann-Whitney U-test as applicable. Results: No significant difference in onset times were observed as far as sensory and motor blockade was concerned between the two groups A and B with p-values of 0.69 and 0.40, respectively. Group B had significantly longer duration of block in comparison with Group A (p<0.001). Two patients in group A and one patient in Group B required supplemental analgesia with fentanyl boluses. Haemodynamics were stable and no complications were seen in both the groups. Conclusion: Lower volume of Bupivacaine is convincingly prudent for regional blockade under USG guidance than suggested in literature.