Evaluation of Addition of Sodium Bicarbonate to Dexamethasone and Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Orthopedic Procedures

Abstract

Background: Peripheral nerve blocks have taken over as the principle technique for upper limb surgeries. A number of adjuvants have been tried individually, but very few studies have investigated the cumulative effect of two or more adjuvants given together along with local anesthetic. Aim: This study aimed to evaluate the effect of addition of sodium bicarbonate to dexamethasone and ropivacaine in supraclavicular brachial plexus block. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) 1 and 2 patients posted upper limb orthopedic procedures. Materials and Methods: Ninety ASA 1 and 2 patients were selected and divided into three groups of 30 each: Group R received 30 mL of 0.75% ropivacaine plus 4 mL normal saline; Group RD 30 mL of 0.75% ropivacaine, 2 mL normal saline and 2 mL of dexamethasone were given; Group RB 30 mL of 0.75% ropivacaine plus 2 mL of dexamethasone and 2 mL of sodium bicarbonate. Onset and duration of sensory and motor block and postoperative pain scores were studied in each group. Statistical Analysis: Student's independent t -test was employed for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal–Wallis test was used for postoperative pain score data. Results: Addition of sodium bicarbonate to dexamethasone and ropivacaine quickens onset and prolongs duration of sensory and motor block. Conclusion: Sodium bicarbonate produces a synergistic and potentiating effect with dexamethasone as adjuvant in supraclavicular brachial plexus block.

Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty

“…Therefore, the precipitates should also be reabsorbed within 2 days in clinical use. The animal study preliminarily indicated that the precipitates were absorbable and safe, and no related side effects were observed in the current and previous clinical trials 20,21 . However, larger long-term follow-up trials are required to further verify the safety of the modified cocktail.…”

“…We selected ropivacaine instead of bupivacaine because of its milder cardiovascular and central nervous system toxicity 32 , and epinephrine and corticosteroids because they potentiate the analgesic effect of ropivacaine [10][11][12]33,34 . We selected MgSO 4 and NaHCO 3 for modifying the conventional cocktail because they have been shown to prolong and enhance the analgesia induced by ropivacaine in surgical procedures other than TKA [17][18][19][20][21] . Our results suggest that these 2 adjuvants deserve further investigation even though they were not mentioned in a recent review of cocktails used in total joint arthroplasty 10 .…”

“…MgSO 4 acts as an N-methyl- d -aspartate (NMDA) receptor antagonist in the nervous system and can enhance and prolong ropivacaine-induced brachial plexus blocks 17-19 . NaHCO 3 also increases the quality and duration of ropivacaine-induced brachial plexus blocks and lumbar peridural blocks by converting the nonionized form of ropivacaine to an ionized form, which could close sodium channels and block nerve impulse conduction 20,21 .…”