TO STUDY THE EFFECT OF FENTANYL AND TRAMADOL AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Abstract

Background: Brachial plexus block is used in our clinical practice as an alternative to general anaesthesia for upper limb surgeries. Peripheral administration of an opioid agonist can theoretically inhibit the propagation of action potentials or the release of excitatory transmitters in primary afferent fibres, but contrasting results have been reported in the clinical setting.

OBJECTIVE: To compare the time of onset, time to achieve complete block, duration, quality, side effect profile and frequency of rescue Analgesia doses between the two groups in Supraclavicular block.

STUDY DESIGN: Prospective Randomised Double-Blind Study

PARTICIPANTS: Patients of either sex aged 20-60 years, belonging to ASA I or II Physical status undergoing upper arm surgery

METHODS: Seventy patients of either sex undergoing upper-arm surgery were recruited for this study. The patients were randomly allocated into 2 groups of 35 patients each.

Group RT: Patients were given 0.5% Ropivacaine 30ml + tramadol 50mg [1ml].

Group RF: Patients were given 0.5% Ropivacaine 30ml + fentanyl 50mcg [1ml].

Evaluation of sensory and motor block was performed till 30 mins intraoperatively and patients were followed till 24 hours postoperatively for the same. Sensory block was assessed via pin-prick and evaluated by VAS scoring. Motor block assessment is done by grades of motor power.

RESULTS: Mean onset of motor block in Group RT was 11.3 minutes while as it was 15.4 minutes in Group RF. Mean onset of sensory block in Group RT was 10.6 minutes while as it was 11.1 minutes in Group RF. Mean interoperative VAS score of Group RT and Group RF at 5 minutes was 5.09 and 6.14, at 10 minutes it was 2.49 and 4.06 in both the study groups. Mean duration of analgesia in hours in Group RT was 14.7 and in Group RF it was 8.6. Rescue analgesia of two doses was needed in 19 patients in Group RT, while as 3 doses were needed in 24 (68%) patients in Group RF. When postoperative complications were compared in two study groups it was observed that nausea was seen in 5 (14.3%) patients in Group RT and 2 (5.7%) patients in RF. Vomiting was seen in 3 (8.6%) patients in Group RT and 1 (2.9%) patients in Group RF, respectively

CONCLUSIONS: In conclusion, tramadol provides better surgical anaesthesia and analgesia. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks.

IMPLICATIONS: Easy Availability without Narcotic drug Licence and better surgical anaesthesia and analgesia when used in nerve blocks as in our study make Tramadol an excellent alternative as an adjuvant in nerve block in comparison to Fentanyl.