Supraclavicular Brachial Plexus Block During Upper Limb Surgeries
Condition: Brachial Plexus Block
Study type: Interventional
Phase: Early Phase 1

Summary: 
      Comparative Study Between Ketamine-Bupivacaine Versus Bupivacaine With Intravenous Ketamine
      Infusion In Supraclavicular Brachial Plexus Block During Upper limb Surgeries The techniques
      of regional anesthesia have become very popular as they provide several advantages in
      comparison with general anesthesia and systemic analgesia.

      They provide perfect pain control, decreased complications and reduced post-anesthesia care
      unit stay.

      Regional anesthesia provides more patient safety and better outcomes, which leads to the fact
      that ultrasound-guided regional anesthesia became more popular.

      Ultrasound provides clinicians with real-time images which are useful for better
      identification of the anatomical structures, safe needle placement and adequate local
      anesthetic spread.

      Brachial plexus blocks are commonly achieved via an interscalene, supraclavicular,
      infraclavicular or axillary approach.

      The supraclavicular level is an ideal site to achieve anesthesia of the entire upper
      extremity just distal to the shoulder as the plexus remains relatively tightly packed at this
      level, resulting in a rapid and high-quality block. For this reason, the supraclavicular
      block is often called the ''spinal of the arm'' Using the local anesthetics alone for
      supraclavicular brachial plexus block provide good operative conditions but have the
      disadvantage of shorter duration of postoperative analgesia. Various adjuvants such as
      opioids, dexmedetomidine, dexamethasone, midazolam, ketamine, etc., were added to local
      anesthetics in brachial plexus block to achieve quick and prolonged block.

      Ketamine is a noncompetitive antagonist of the N-methyl-D aspartate receptor(NMDAR).

      It is used as a premedication, and for sedation, induction and maintenance of general
      anesthesia.

      Local anesthetic and analgesic properties have been reported for ketamine. Intravenous
      administration of low-dose ketamine decreases postoperative opioid use and improves
      analgesia.

      Ketamine has been added to bupivacaine to prolong the duration of regional anesthesia and
      postoperative analgesia.
    


Intervention name(s): Bupivacaine-ketamine injection; Bupivacaine injection with intravenous ketamine infusion
Intervention type(s): Drug; Drug
Intervention description(s): 20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus ketamine (1 mg/kg) with maximum dose 100mg ; the total volume is 30 ml with the infusion of 100 ml normal saline at a rate of 100ml/h.; 20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus 10 ml saline ; the total volume is 30 ml with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline and will be infused at a rate of 100 ml/h, which will be stopped 5 min before the end of surgery.
Intervention MeSH terms: Ketamine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Bupivacaine; ketamine; Brachial Plexus Block