P. V. Shiva, T. Anudeep Kumar
BACKGROUND The addition of adjuncts like Neostigmine, opioids, midazolam, dexmedetomidine, hyaluronidase, clonidine etc., to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Fentanyl, a phenylpiperidine derivative, is known to produce antinociception and enhance the effect of local anaesthetics when given epidurally or intrathecally. The purpose of the present study is to assess the effect of fentanyl added to brachial plexus block by axillary approach. MATERIALS AND METHODS A prospective, randomized, single blinded study was conducted on 100 patients of either sex, belonging to 15-55 years of age. ASA grade I and II admitted to Osmania General Hospital for upper limb surgeries from 2015-2017 were operated under axillary approach of brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 50) were administered 40 ml of 0.25% Bupivacaine and Group BF (n = 50) were given 40mL of 0.25% Bupivacaine with preservative free fentanyl 2.5 μg/ml. The onset time and duration of sensory and motor blockade were recorded. Haemodynamic variables (i.e., heart rate, blood pressure and oxygen saturation), sedation scores and rescue analgesic requirements were recorded for 24 hrs. postoperatively. RESULTS The duration of sensory and motor block was significantly longer in Group BF compared to Group B (p <0.05), however onset of sensory and motor block was significantly prolonged in group BF compared to group B (p <0.05). Rescue analgesic requirements were significantly less in Group BF compared to Group B (p <0.05). Haemodynamics and sedation scores did not differ between the two groups in the post-operative period. CONCLUSION Fentanyl (2.5 μg/ml) in combination with 40mL of Bupivacaine (0.25%) caused significant prolongation of duration of sensory and motor block (p<0.05) but delayed the onset of both sensory and motor blockade compared to bupivacaine alone and reduced requirements for rescue analgesics and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events.
