Duration of Blockade of Peripheral Nerves With Bupivacaine Depending of the Adjuvants

Study Overview
=================
Brief Summary
-----------------
The main aim of the investigator's study is to propose combination of local anesthetics and adjuvants that provides both adequate anesthesia during surgery and prolonged post-operative analgesia.

Detailed Description
-----------------
Peripheral nerve plexuses blocks are performing as a component of analgesia in patients undergoing orthopedic surgery on the upper or lower extremities. Patients are divided into two groups depending on the adjuvant to the local anesthetic: 1st group - patients whose blockade is performed with a solution of bupivacaine 0.375% together with dexamethasone 0.02%; Group 2 - patients whose blockade is performed with a solution of bupivacaine 0.375% together with dexamethasone 0.02% and epinephrine 0.00018%. The duration of the blockade is estimated by puncturing the skin with a needle. The intensity of pain is assessed at 6, 12, 24 and 36 hours after blockade using Visual analog scale (VAS). The amount of narcotic anesthetic used in the postoperative period is also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36 hours after surgery.

Official Title
-----------------
Duration of Blockade of Peripheral Nerves With Low Concentrated Bupivacaine Solution Depending of the Adjuvants

Conditions
-----------------
Postoperative Pain, Peripheral Neuropathy, Fractures of the Upper Limb, Fracture of the Lower Limb (Except Hip), Initial Encounter, Intraoperative Hypotension, Intraoperative Hypertension, Pain Syndrome, Anesthesia, Anesthesia, Local, Local Anesthetic Systemic Toxicity

Intervention / Treatment
-----------------
* Drug: Bupivacaine, dexamethasone, epinephrine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients undergoing upper or lower extremity orthopedic surgery Exclusion Criteria: diabetes mellitus; diseases of the peripheral nerv system

Ages Eligible for Study
-----------------
Minimum Age: 12 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Bupivacaine with dexamethasone<br>Ultrasound guided peripheral nerve block for upper or lower extremity was performed before orthopedic surgery using neurostimulator. Twenty milliliters solution of bupivacaine 0,375% with dexamethasone was injected for one plexus or peripheral nerve. | Drug: Bupivacaine, dexamethasone, epinephrine<br>* Bupivacaine 75 mg, dexamethasone 4 mg, epinephrine 0,18 mg<br>|
| Bupivacaine with dexamethasone and epinephrine<br>Ultrasound guided peripheral nerve block for upper or lower extremity was performed before orthopedic surgery using neurostimulator. Twenty milliliters solution of bupivacaine 0,375% with dexamethasone 0,02% and epinephrine 0,00018% was injected for one plexus or peripheral nerve. | Drug: Bupivacaine, dexamethasone, epinephrine<br>* Bupivacaine 75 mg, dexamethasone 4 mg, epinephrine 0,18 mg<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The duration of blockade | The duration of the blockade was estimated by puncturing the skin with a needle every hour. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36 hours after surgery. | 6th, 12th, 24th and 36th hours after blockade | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The amount of narcotic anesthetic used in the postoperative period |  | 48 hour after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Regional anesthesia, Pain management, Local anesthetic, Electromyography