Fentanyl Versus Tramadol as Co-administrator to Bupivacaine
Condition: Acquired Deformity of Elbow; Forearm; Hand; Wrist
MeSH terms: Congenital Abnormalities
Study type: Interventional

Summary: 
      Supraclavicular brachial plexus approach is an alternative technique to general anesthesia
      resulting in a fast onset of a reliable blockage of the brachial plexus. The use of
      ultrasound for the performance of supraclavicular block has become the gold standard since it
      enables the clinician to deposit the local anesthetic close to the nerves in real-time that
      improves the success rate with a safety margin. Adjuvants are added to local anesthetic in
      Supraclavicular Brachial Plexus Blockade to improve the quality of nerve blocks and the
      duration of analgesia. It should be noted that no adjuvant has been approved by the Food and
      Drug Administration (FDA) for the prolongation of peripheral nerve blocks
    

Detailed description: 
      There are multiple controversies among the previous studies for the use of different opioids
      as adjuvants for brachial plexus blockade to improve various block characteristics. Moreover,
      limited studies estimate the pons and cons of tramadol versus fentanyl as co-administrator to
      bupivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Blockade.

      In our study, we aim to assess the utility of fentanyl versus tramadol as co-administrator to
      bupivacaine in ultrasound-guided supraclavicular brachial plexus blockade in upper limb
      surgeries in a prospective randomized controlled fashion. The primary outcome is to compare
      between the efficacy of tramadol versus fentanyl as adjuvants on the onset and duration of
      sensory and motor block and the secondary outcome is to compare between the efficacy of
      tramadol versus fentanyl as adjuvants on postoperative analgesia, time of the request to
      rescue analgesia, postoperative analgesic consumption, and complications.

      The patients were aged between 18 and 60, both gender, and the American Society of
      Anesthesiologists (ASA) physical status I/II. However, patients who had bleeding disorders
      got opioid analgesics or monoamine oxidase inhibitors before surgery, had a history of
      seizures, respiratory or cardiac diseases, local infections at the site where needle for the
      block is to be inserted, pregnant woman and in whom the block effect was partial and required
      supplementary anesthesia were excluded from the study.

      Patients were randomly allocated into three groups for ultrasound-guided supraclavicular
      brachial plexus block. Randomization was established using the computer-generated closed
      envelopes method.

      Group B (bupivacaine group): patients received 20 ml bupivacaine 0.5% plus 2 ml normal saline
      Group F (fentanyl group): patients received 20 ml bupivacaine 0.5% plus fentanyl (1µg/kg-2
      ml) Group T (tramadol group): patients received 20 ml bupivacaine 0.5% plus tramadol
      (1mg/kg-2 ml)
    

Intervention name(s): ultrasound-guided supraclavicular brachial plexus blockade
Intervention type(s): Procedure
Intervention description(s): Ultrasound-guided supraclavicular brachial plexus block was done using an ultrasound machine (Philips; Model: OTD020, AcBel Polytech Inc., Taiwan) with a 5-10 MHz linear probe. The brachial plexus and its relation to the surrounding structures were viewed while the patient was supine and the head turned 45° to the contralateral side. In the supraclavicular fossa, the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. After skin sterilization and local anesthetic administration, an insulated needle was then introduced lateral to the ultrasound probe and parallel to the long axis of the probe. Once the needle penetrated the brachial plexus cluster, the local anesthetic mixture was injected incrementally after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Supraclavicular Brachial Plexus Blockade; Fentanyl; Tramadol