Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan-Mar;11(1):40-46.
doi: 10.4103/0259-1162.200225.

Perineural Nalbuphine in Ambulatory Upper Limb Surgery: A Comparison of Effects of Levobupivacaine with and without Nalbuphine as Adjuvant in Supraclavicular Brachial Plexus Block - A Prospective, Double-blinded, Randomized Controlled Study

Anjan Das  1 , Sandip RoyBasunia  2 , Anindya Mukherjee  3 , Hirak Biswas  1 , Rajasree Biswas  4 , Tapobrata Mitra  5 , Surajit Chattopadhyay  1 , Subrata Kumar Mandal  1
Affiliations

Perineural Nalbuphine in Ambulatory Upper Limb Surgery: A Comparison of Effects of Levobupivacaine with and without Nalbuphine as Adjuvant in Supraclavicular Brachial Plexus Block - A Prospective, Double-blinded, Randomized Controlled Study

Anjan Das et al. Anesth Essays Res. 2017 Jan-Mar.

Abstract

Background and aims: Various opioid additives have been trialed to prolong brachial plexus block. We evaluated the effect of adding nalbuphine hydrochloride to levobupivacaine for supraclavicular brachial plexus blockade. The primary end-points were the onset and duration of sensory and motor blocks and duration of analgesia.

Materials and methods: Seventy-eight patients (aged 25-45 years) posted for ambulatory forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Groups LN and LC) in a randomized, double-blind fashion. In Group LN (n = 39), 30 ml 0.5% levobupivacaine + 10 mg (diluted in 2 ml 0.9% saline) nalbuphine hydrochloride, and in Group LC (n = 39), 30 ml 0.5% levobupivacaine + 2 ml normal saline (0.9%) were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics, and side effects were recorded for each patient.

Results: Although with similar demographic profile and block (sensory and motor) onset time, sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in Group LN (P < 0.05) than Group LC. Postoperative VAS value at 24 h was significantly lower in Group LN (P < 0.05). Intraoperative hemodynamics was comparable between two groups, and no any appreciable side effect was noted throughout the study period.

Conclusion: It can be concluded that adding nalbuphine hydrochloride to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects.

Keywords: Levobupivacaine; nalbuphine hydrochloride; supraclavicular brachial plexus block.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Duration of sensory and motor blocks.
Figure 2
Figure 2
Time of first intramuscular diclofenac injection as rescue analgesic.
Figure 3
Figure 3
Comparison of visual analog scale score between Group LN and Group LC.
Flowchart 1
Flowchart 1
CONSORT 2010 flow diagram.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: A survey of 5,703 patients. Can J Anaesth. 2004;51:886–91. - PubMed
    1. Fortier J, Chung F, Su J. Predictive factors of unanticipated admission in ambulatory surgery: A prospective study. Anesthesiology. 1996;85:A27.
    1. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg. 2012;20:38–47. - PubMed
    1. Foster RH, Markham A. Levobupivacaine: A review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–79. - PubMed
    1. Crews JC, Foreman AS, Weller RS, Moss JR, Tucker SP. Onset, duration, and dose tolerability of levobupivacaine 0.5% for axillary brachial plexus neural blockade. Anesthesiology. 1998;89:A894.