Main Article Content

Abstract

BACKGROUND


Regional anaesthetic technique has many advantages over general anesthesia. The supraclavicular brachial plexus block due to its rapid onset and reliability offers dense anesthesia of brachial plexus for surgeries at or distal to elbow. The additives like injection Fentanyl and injection Butorphanol along with 0.5% injection Bupivacaine have been proved to be efficient for supraclavicular block. However their effects haven't been compared by using them as additives in 0.5% Injection Ropivacaine.


Aims


To compare the sensory and motor block characteristics of injection Butorphanol and injection Fentanyl in injection Ropivacaine.


METHODS


This prospective single blinded randomised control study included 60 patients (ASA I or II; 18- 60 yrs) scheduled for upper limb surgeries. Patients were randomly allocated to two groups of 30 each and supraclavicular block was given as per distribution (Group B: 30 ml 0.5 % injection Ropivacaine with 2mg injection Butorphanol and Group F: 30 ml 0.5 % injection Ropivacaine with 100 mcg injection Fentanyl). The hemodynamic parameters were recorded at baseline, post block and till 45 mins. Sensory and motor block assessments were done along with sedation score determination. Duration of sensory and motor block was noted.


RESULTS


The group with injection Fentanyl as additive had earlier onset of motor blockade. Time required to achieve sensory blockade was less in Group F. Duration of sensory and motor block prolonged in Group F.


CONCLUSIONS


Injection Fentanyl as additive in injection Ropivacaine provided earlier onset of motor block and decreased total time required to achieve maximum sensory block with prolonged duration and decreased requirements of rescue analgesia.

Keywords

Butorphanol, Fentanyl, Ropivacaine, Supraclavicular Block.

Article Details

How to Cite
Veena Arvind Ganeriwal, & Juilee Ajit Salvi. (2024). Comparative Study of Injection Butorphanol Versus Injection Fentanyl with Injection Ropivacaine in Ultrasound Guided Supraclavicular Block to Evaluate Sensory and Motor Block Characteristics. Journal of Evolution of Medical and Dental Sciences, 13(5), 117–123. https://doi.org/10.14260/jemds.v13i5.634

References

  1. Raghove P, Singh K, Taxak S, et al. Comparison of ultrasound guided technique with conventional landmark technique for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery. International Journal of Pharmacology and Clinical Sciences 2016;5(1).
  2. Gauss A, Tugtekin I, Georgieff M, et al. Incidence of clinically symptomatic pneumothorax in ultrasound‐guided infraclavicular and supraclavicular brachial plexus block. Anaesthesia 2014;69(4):327-36.
  3. Raghove P, Singh K, Taxak S, et al. Comparison of ultrasound guided technique with conventional landmark technique for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery. International Journal of Pharmacology and Clinical Sciences 2016;5(1).
  4. Kapral S, Krafft P, Eibenberger K, et al. Ultrasound- guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994;78(3):507-13.
  5. Arbona FL, Khabiri B, Norton JA. Ultrasound-guided regional anesthesia: a practical approach to peripheral nerve blocks and perineural catheters. Cambridge University Press 2011.
  6. Rubin JM, Bude RO, Carson PL, et al. Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. Radiology 1994;190(3):853-6.
  7. Bondestam S, Kreula J. Needle tip echogenicity: a study with real time ultrasound. Investigative Radiology 1989;24(7):555-60.
  8. Leinberry C, Wehbé MA. Brachial plexus anatomy. Hand Clinics 2004;20(1):1-5.
  9. Feigl G, Aichner E, Mattersberger C, et al. Ultrasound- guided anterior approach to the axillary and intercostobrachial nerves in the axillary fossa: an anatomical investigation. Br J Anaesth 2018;121(4):883-9.
  10. Chan VW. Applying ultrasound imaging to inter scalene brachial plexus block. Regional Anesthesia & Pain Medicine 2003;28(4):340-3.
  11. Leone S, Di Cianni S, Casati A, et al. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed 2008;79(2):92-105.
  12. Gray AT, Schafhalter-Zoppoth I. “Bayonet artifact” during ultrasound-guided transarterial axillary block. The Journal of the American Society of Anesthesiologists 2005;102(6):1291-2.
  13. Owen MD, Dean LS. Ropivacaine. Expert Opinion on Pharmacotherapy 2000;1(2):325-36.
  14. Revar B, Patel V, Patel B, et al. A comparison of epidural butorphanol tartrate and tramadol hydrochloride for postoperative analgesia using csea technique. Int J Res Med 2015;4(1):1-6.
  15. Cartwright MS, Shin HW, Passmore LV, et al. Ultrasonographic findings of the normal ulnar nerve in adults. Archives of Physical Medicine and Rehabilitation 2007;88(3):394-6.
  16. Commiskey S, Fan LW, Ho K, et al. Butorphanol: effects of a prototypical agonist-antagonist analgesic on κ-opioid receptors. Journal of Pharmacological Sciences 2005;98(2):109-16.
  17. Armenian P, Vo KT, Barr-Walker J, et al. Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review. Neuropharmacology 2018;134:121-32.
  18. Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. Fentanyl. In StatPearls [Internet]. StatPearls Publishing 2022.
  19. Bhavsar GM, Shah RB, Chavda HK, et al. Use of butorphanol as an adjuvant to local anaesthetics in brachial plexus block for upper limb surgery. PIJR 2016;5(7):169-72.
  20. Kapse US, Bhalerao PM. Comparison of bupivacaine with fentanyl and bupivacaine with butorphanol for brachial plexus block by axillary approach- a prospective, double blind, randomized study. Int J Res Med Sci 2017;5(4):1415-8.
  21. Kulkarni VR, Naik S, Mishra L. Comparative study of butorphanol versus fentanyl with bupivacaine in supraclavicular approach of brachial plexus block. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2018;17(3):53-60.
  22. Madhusudhana R, Kumar K, Kumar R, et al. Supraclavicular brachial plexus block with 0.75% ropivacaine and with additives tramadol, fentanyl-a comparative pilot study. Int J Biol Med Res 2011;2(4):1061-3.
  23. Kumari A, Chhabra H, Gupta R, et al. Comparative study of effectiveness of tramadol and butorphanol as adjuvants to levobupivacaine for supraclavicular brachial plexus block. Anesth Essays Res 2019;13(3):446-51.
  24. Dershwitz M, Rosow CE, DiBiase PM, et al. Comparison of the sedative effects of butorphanol and midazolam. Anesthesiology 1991;74(4):717-24.
  25. Yaghoobi S, Seddighi M, Yazdi Z, et al. Comparison of Postoperative Analgesic Effect of Dexamethasone and Fentanyl Added to Lidocaine through Axillary Block in Forearm Fracture. Pain Res Treat 2013;2013:761583.
  26. Gowthaman TB, Singh AK, Sinha GK. Comparative Study of Levobupivacaine with Butorphanol and Ropivacaine with Butorphanol in Supraclavicular Brachial Plexus Block. Annals of International medical and Dental Research 2019;5(3):12-4.
  27. Karakaya D, Büyükgöz F, Barş S, et al. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Regional Anesthesia & Pain Medicine 2001;26(5):434-8.