Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block

Abstract

Background In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia. Aim of the Work is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study. Results Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P < 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups. Conclusion Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.