Comparison between Ropivacaine 0.5% And Levobupivacaine 0.5% in Axillary Brachial Plexus Block for Upperlimb Surgeries in a Tertiary Health Care Centre of Tripura- A Observational Study

Abstract

Introduction Axillary brachial plexus block is an anesthetic option used for surgeries of arm, forearm and elbow. The use of USG has significantly improved the quality of nerve blocks by direct visualization of nerves and related anatomical structures, needle trajectory and spread of local anesthesia during injection and significantly increases the success rate. Various drugs like Ropivacaine, bupivacine and Levobupivacaine are preferred due to greater margin of safety. However the efficacy of Levobupivacaine in Axillary Brachial Plexus Block has not been studied much. Therefore ,we designed this study to compare the clinical effect of Ropivacaine with Levobupivacaine for ABPB using USG technique. Methodology It’s a hospital- based Comparative study done in Department of Anesthesiology, AGMC & GBPH from July 2016 to June 2018 (2 years) where 60 patients aged between 18-55 years with ASA grade 1 & 2 who are posted for upper limb surgery were randomly allocated into two groups of 30 each. Patients belonging to ASA grade (3& 4) and age <18years,>55years, Patient with h/o bleeding diathesis, neuromuscular disorder, morbid obesity, prolonged drug therapy & local site infection were excluded from the study. USG guided axillary nerve block performed under aseptic condition. Sensory and motor blocks were assessed in each nerve territory at 2, 5, 10, 15, 20, 25, and 30 mins, 6 hr, 12 hr , 18hr, and 24 hrs after LA injection after LA injection. Onset of block, duration block and quality of analgesia has been compared. For the duration of the study, the presence of hypotension, bradycardia, hypoxia or nausea and vomiting was recorded and treated according to standard clinical practice. Result Among 60 study subjects Mean age was 34.7±12.6 years and majority of the study subjects were males (73.3%) and 26.7% were females. The pre-operative parameters e.g. age, sex, body weight etc. were compared between two groups but there was no statistically significant difference between the two groups (p>0.05). The onset of motor blockade among patients of Ropivacaine group was also shorter than patients received Levobupivacaine which was significant. Duration of sensory blockade was shorter in Ropivacaine group & duration of motor blockade was also shorter in Ropivacaine group than Levobupivacaine group and these difference were found to be statistically significant (p<0.05). There was no significant change in vital parameters after administration of both the drugs when observed at specific time intervals. VAS Scores were comparable in both the groups. Conclusion The following conclusion can be made from the present study • Ropivacaine has faster onset of sensory and motor blockade when compared with Levobupivacaine. • But duration of both sensory and motor blockade was lesser than Levobupivacaine • Ropivacaine provides stable haemodynamic profile similar to Levobupivacaine. • It provides satisfactory intra-operative &post-operative analgesia comparable to Levo