A Comparative Study Between 0.125% Bupivacaine and 0.2% Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block Using a Perineural Catheter for Postoperative Analgesia in Upper Limb Surgeries

Abstract

Introduction: Regional anesthesia offers the anesthesiologist, the surgeon, as well as the patient with better advantages over general anesthesia such as being conscious throughout the surgery, avoiding multiple drugs, better hemodynamic stability, excellent postoperative analgesia, and faster per oral consumption after surgery. Compared with the axillary approach, brachial plexus block at the level of clavicle can anesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. The aim of the study was to assess the duration of postoperative analgesia using visual analog scale and onset of motor blockade in two groups – bupivacaine group and ropivacaine group. Materials and Methods: A single-blinded, randomized, prospective experimental study was conducted in the Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital a Tertiary Care Teaching Hospital in South India from November 2019 to May 2021. Sixty patients undergoing upper limb surgeries were randomized into two groups – bupivacaine and ropivacaine. All patients were administered 25 mL of 0.5% bupivacaine as the standard intraoperative drug and at the end of 3 h study drug was administered accordingly. We assessed onset of sensory and motor blockade, duration of block, hemodynamic parameters, and duration for first rescue analgesia. The duration of postoperative analgesia was the primary outcome, and onset of motor blockade and time of first rescue analgesia required were the secondary outcomes. The statistical significance between the groups was analyzed using the Chi-square test for categorical variables, and ANOVA test for continuous variables a P < 0.05 was considered statistically significant. Results: We observed that 0.125% bupivacaine group had prolonged duration of action (25 h) than 0.2% ropivacaine group (16.9 h) with P < 0.001. The onset of motor block of both drugs was found to be similar in both groups, but it was not found to be statistically significant (P = 0.786). Conclusion: 0.125% bupivacaine provides longer duration for postoperative analgesia given through perineural catheter than 0.2% ropivacaine in ultrasound-guided supraclavicular blocks for upper limb surgeries.