Effect of verapamil as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block

Abstract

Background: The quest for searching newer and safer anaesthetic agents has always been one of the primary needs in anaesthesiology practice. Levobupivacaine, the pure s (-) enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling. Also, many adjuvants have been used with local anaesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with Levobupivacaine. Aims: The primary aim of the study is to know the effect of verapamil (5mg) as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block. Methods: A Descriptive, Observational study was carried out in 80 ASA Grade I and II patients, undergoing upper limb surgeries under supraclavicular brachial plexus block using ultrasound machine. Local anaesthetic solution was prepared as following. 30ml 0.5% Levobupivacaine + 2ml Verapamil (5mg). The effect of Verapamil as an adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block with regards to onset and duration of motor and sensory block, duration of analgesia, need for rescue analgesia and number of rescue analgesia in first 24 hours after surgery was evaluated. Data analysis was done with the help of SPSS Software ver 13. Results: Mean onset time for motor block in our study group was 9.19 ± 1.86min The mean duration of motor block in our study group was 470.25 ± 42.00 min The mean onset time for sensory block in our study group was 6.48 ± 2.55 min The mean duration of sensory block in our study group was 494.88 ± 37.67 min The mean duration of analgesia in our study group was 517. 88 ± 48.24 The mean no of reuse analgesia required in the first 24 hours after surgery was 3 Conclusion: Verapamil (5 mg) 2 ml can be effectively and safely used as an adjuvant to Levobupivacaine (0.5%) 30ml in Supraclavicular Brachial Plexus Block. However, due to paucity of studies in literature, there is still scope for further study using different calcium channel blocking drugs or in different dosage strengths.