Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study

Sayyed, Hayam G; Idriss, Naglaa K.; Gaber, Marwa A.; Sayed, Sohair K.; Ahmed, Rasha

doi:10.1159/000489647

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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Adjuvants in clinical regional anesthesia practice: A comprehensive review

Prabhakar

Lambert

Kaye

et al. 2019

Best Practice & Research Clinical Anaesthesiology

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Comparative study between magnesium sulfate and ketamine added to lidocaine in ultrasound-guided supraclavicular brachial plexus block in upper limb surgery

Kemary¹,

Ashry²,

Awad³

et al. 2019

The Scientific Journal of Al-Azhar Medical Faculty, Girls

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Introduction Supraclavicular brachial plexus (SBP) block is an excellent substitute for general anesthesia during upper limb operations. It prevents undesirable effects of using general anesthesia and upper airway instruments. Moreover, it reduces the duration of hospitalization and costs and provides complete muscle relaxation. The ultrasound-guided technique requires a lower anesthetic volume to provide an efficient block and decreases the risk associated with intravascular injections and trauma to the surrounding tissues. Aim We conducted this study to compare the effect of ketamine versus magnesium sulfate as additives to lidocaine on onset and duration of sensory and motor block and duration of analgesia time, postoperative visual analog scale (VAS), total analgesic need, stress response (cortisol and blood glucose), and adverse effects in ultrasound-guided supraclavicular brachial plexus (SBP) block for patients who electively underwent upper limb surgeries. Patients and methods A total of 90 patients aged 21–65 years, with American Society of Anesthesiologists status I, II, and III, scheduled for elective upper limb surgeries under SBP block, were divided into three equal groups in a randomized controlled fashion: group C (n=30) received 25 ml 2% lidocaine plus 5 cm saline, group K (n=30) received 25 ml 2% lidocaine plus 2 mg/kg ketamine, and group M (n=30) received 25 ml 2% lidocaine plus 250 mg magnesium sulfate (total volume in all groups 30 ml). Hemodynamic variables such as mean arterial blood pressure and heart rate, onset and duration of sensory and motor block, postoperative VAS, time to first analgesic request, total analgesic need, stress response (cortisol and blood glucose), and adverse effects were recorded for each patient. Results The sensory block duration was 438.0±80.4 min in group K, 280.2±42.6 min in group M, and 132.0±24.6 min in group C, with a P value less than 0.001, which was statistically significant, whereas the motor block duration was 500±79 min in the group K, 342±50 min in group M, and 200±35 min in group C, with a P value less than 0.001, which was statistically significant, indicating a prolongation in block duration in the ketamine group followed by magnesium group and then control group. The most significant and highest VAS pain scores were found in the control group at all time points (P<0.001), whereas the K group had the lowest VAS. Postoperative analgesic requirement was less in K group when compared with other groups (P<0.001). Conclusion Both ketamine and magnesium sulfate prolong the duration of analgesia without any major adverse effects. Ketamine is a better adjuvant to lidocaine for SBP than magnesium sulfate, as it has lower VAS and less postoperative analgesic requirement in upper limb surgeries.

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Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study

Cited by 3 publications

References 25 publications

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Adjuvants in clinical regional anesthesia practice: A comprehensive review

Comparative study between magnesium sulfate and ketamine added to lidocaine in ultrasound-guided supraclavicular brachial plexus block in upper limb surgery

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