Fentanyl as an adjuvant for brachial plexus block: a randomized comparative study
Background: Adjuvants are known to enhance the effect of local anaesthetics (LA). Several adjuvants have been suggested to enhance the duration and analgesic effect of local anesthetic agents. We designed this randomized single blinded prospective study to compare the analgesic efficacy of Fentanyl used as an adjuvant to ropivacaine for supraclavicular brachial plexus block in patients undergoing orthopaedic surgeries of forearm.
Methods: For this randomised prospective, single blinded study 66 ASA I and II patients aged 18-65 years were included and were divided into 2 groups, group R (35) and RF (31). Supraclavicular brachial plexus block was performed in the group R using 0.5% ropivacaine 30 ml plus 1 ml NS (total 31 ml) and in group RF received 0.5% ropivacaine plus 50 micrograms fentanyl in 1 ml NS (total 31 ml) in brachial plexus block. The onset time of sensory and motor block, duration of sensory and motor block were recorded.
Results: Compared to group R, group RF showed a significant greater duration of sensory and motor blockade (𝑃=0.0001). Demographic parameters and block onset time were comparable in both the groups.Conclusions: The addition of fentanyl to ropivacaine significantly prolonged the duration of analgesia compared to ropivacaine used alone for supraclavicular brachial plexus blocks in patients undergoing forearm surgeries.
Woolf CJ, Thompson SWN. The induction and maintenance of central sensitization is dependent on N-methyl-Daspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44(3):293-9.
Richman JM, Liu SS, Courpas G. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesthesia and Analgesia. 2006;102(1):248-57.
McClure JH. Ropivacaine. Br J Anaesthesia. 1996;76:300-7.
McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs. 2000;60:1065-93.
Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-9.
Ray M, Mondal SK, Biswas A. Caudal analgesia in paediatric patients: comparison between bupivacaine and ropivacaine. Indian J Anaesth. 2003;47:275-8.
Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Intern Anesthesiol Clinic. 2011;49(4):104-16.
Gormley WP, Murray JM, Fee JPH, Bower S. Effect of the addition of alfentanil to lignocaine during axillary brachial plexus anaesthesia”. British J Anaesthesia. 1996;76(6):802-5.
Viel EJ, Eledjam JJ, Coussaye de la JE, Athis FD. Brachial plexus block with opioids for postoperative pain relief: comparison between buprenorphine and morphine. Regional Anesthesia. 1989;14(6):274-8.
Nishikawa K, Kanaya N, Nakayama M, Igarashi M, Tsunoda K, Namiki A. Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Anesthesia and Analgesia. 2000;91(2):384-7.
Karakaya D, B¨uy¨ukg¨oz F, Baris S, G¨uldo˘gus F, T¨ur A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesthes Pain Med. 2001;26(5):434-8.
Fletcher D, Kuhlman G, Samii K. Addition of fentanyl to 1.5% lidocaine does not increase the success of axillary plexusblock. Reg Anesth. 1994;19(3):183-8.
Racz H, Gunning K, Della Santa D, Forster A. Evaluation of the effect of perineuronal morphine on the quality of postoperative analgesia after axillary plexus block: a randomized double-blind study. Anesth Analg. 1991;72(6):769-2.
Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993;76(1):182-91.
Gissen AJ, Gugino LD, Datta S, Miller J, Covino BG. Effects of fentanyl and sufentanil on peripheral mammalian nerves. Anesth Analg. 1987;66(12):1272-6.
Yaksh TL. Multiple opioid receptor systems in brain and spinal cord. Eur J Anaesthesiol, 1984;1:171-99.
Sibinga NE, Goldstein A. Opioid peptides and opioid receptors in cells of the immune system. Annu Rev Immunol. 1988;6:219-49.
Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL et al. Multiple opiate receptor sites on primary afferent fibres. Nature. 1980;284:351-3.
Madhusudhana R, Kumar K, Kumar R, Potli S, Karthik D, Kapil M. Supraclavicular brachial plexus block with 0.75 % ropivaciane and with additives tramadol, fentanyl:a comparative pilot study. Int J Biol Med Res. 2011;2(4):1061-3.