Background: Upper extremity surgeries are recently performed under regional anesthesia. Regional anesthesia of the upper extremity has several advantages over general anesthesia, such as improved postoperative pain, decreased postoperative narcotic consumption, and reduced recovery time. Supraclavicular approach of the brachial plexus block has gained importance for surgical and interventional pain management purposes. Supraclavicular brachial plexus block provides an ideal condition for surgery of the upper limb, maintains hemodynamic stability, decreases postoperative pain and allows for early ambulation. However, the duration of the supraclavicular brachial plexus block is limited by the duration of action of the local anesthetic used in the block.
Aim of the Work: The aim of this study is to evaluate whether additional anesthetic effects could be derived from addition of verapamil into local anesthetics injected into brachial plexus sheath.
Patients and Methods: This study was a prospective, randomized, controlled, double blind study had been carried out in Matareya Teaching Hospital on 60 adult patients with a physical status ASA I & II classification scheduled for upper limb surgeries for 6 months. Patients were randomly classified using sealed envelopes into two equal groups (group I & group II) each of 30 patients. Group I: 30 patients who received 40 ml of 1% lignocaine (20ml) with 0.25% bupivacaine solution (20ml), Group II: 30 patients who received 40 ml of 1% lignocaine(20ml) with 0.25% bupivacaine solution with 2.5mg verapamil (20ml).
Results: Onset of sensory blockade time was marginally faster in Group II (12 ±1.8minutes) as compared to Group I (12.6 ± 1.4 minutes). However this difference was statistically not significant. The increase in duration of sensory blockade in Group II (209.90 ± 13.22 minutes) as compared to Group I (183.80 ± 11.68 minutes) was statistically significant (p < 0.001). Increase in duration of motor blockade in Group II (172.00 ± 9.32minutes) as compared to Group I (168.20 ± 8.91 minutes) was statistically not significant (p = 0.112).
Conclusion: we conclude that adding 2.5 mg verapamil with 0.25% bupivacaine solution (20ml) with 1% lignocaine (20ml) to brachial plexus block can prolong sensory anesthesia without significant effect on duration of motor block, onset of sensory and motor block.