Title: Comparative Study of Alkalined Lignocaine, Addition of Potassium Chloride to Lignocaine and Plain Lignocaine on Onset and Duration of Brachial Plexus Block By Supraclavicular Approach
Authors: Dhananjay Ambike, Narendra P L, D S Thoarat, Pushpa Agarwal, Maroof Ahmad Khan
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.63
Background: Several adjuvants have been used to hasten the onset and prolong the duration of analgesia during bracheal plexus block .In our study we evaluate clinically and co rrrelate the effect of addition of 2 ml of sodium bicarbonate and 0.2 mmol of potassium chloride to 1,5% lignocaine hydrochloride for supraclavicular bracheal plexus block Methods 75 ASA I and II patients posted for elective and emergency upper limb surgery were included and divided into three groups A receiving 30cc lignocaine 1.5% with adrenaline, B receiving 30 cc lignocaine 1.5% with adrenaline and 2 ml sodium bicarbonate and C receiving 30 cc lignocaine 1.5% with 0,2 mmol potassium chloride .The groups were assessed for the onset ,duration and intensity of analgesia. Statistical Analysis-One way ANOVA and Tukey Post Hoc analysis Results: The onset of motor blockade with lignocaine is earlier with lignocaine and sodium bicarbonate 4.10 ±0.9 mins v/s 9.1±1.5 and 9.2±1.9 mins There is no significant difference in the onset of motor blockade in the groups receiving Lignocaine and lignocaine and potassium chloride. The duration of both sensory 132 ±6.5 v/s 88 ±8.2 and 110±5.0 mins and motor blockade120±6.7 v/s 81±7.5 and 102±4.2 mins is longer in the group receiving lignocaine and potassium chloride . Keywords – Adjuvant, duration ,brachial plexus block, potassium 1. Mullen A Chinn , Wirjottamadia K ,Prolonging local anaesthesia : The Lancet 1967: 290:7520:835 2. DiFasio CA, Carron H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA. Comparison of pH-adjusted lidocaine solutions for epidural anesthesia. Anesth Analg 1986;65:760-4 3. Hilgier M. Alkalinization bupivacaine for brachial plexus block. Reg Anaesth 1985;10:59-61 4. Kircha S, Barsa J, Fink BR. Potentiation of nerve block in vivo by physiological adjuvants in the solution. Br J Anaesth. 1983 Jun;55(6):549-53 5. Loder RE A local-anaesthetic solution with longer action. Lancet. 1960 Aug13;2(7146):346 7. 6. Scott DB ,Hyaluronidase in epidural analgesia. Br J Anaesth. 1956 Apr;28(4):187-93. 7. McKeown DW, Scott DB. Influence of the addition of potassium to 0.5% prilocaine solution during I.V. regional anaesthesia. Br J Anaesth. 1984 Oct;56(10):1167-70. 8. Navaratnarajah M, Davenport HT The prolongation of local anaesthetic action with dextran. The effect of molecular weight Anaesthesia. 1985 Mar;40(3):259-62. 9. Parnass SM, Ivankovich AD Alkalinized bupivacaine in brachial plexus blocks. Anesth Analg. 1988 Oct;67(10):1017-8. 10. Stenenson A ,Adriani J Hyde E The efficacy and adverse effects of vasoconstrictors used as adjuvants in regional anaesthesia Anaesth Analg 1964 Sep-Oct;43:495-500. 11. Drachman D, Strichartz G Potassium channel blockers potentiate impulse inhibition by local anesthetics Anesthesiology. 1991 Dec;75(6):1051-61. 12. Bromage PR, Gertel M Improved brachial plexus blockade with bupivacaine hydrochloride and carbonated lidocaine. Anesthesiology. 1972 May;36(5):479-87 13. Sukhani Radha and Winnie AP : Clinical pharmacokinetics of carbonated local anaesthetics I : Subclavian perivascular brachial block model. Anaesth Analg 1987; 66: 739-45 14. Capogna G, Celleno D, Laudano D, Giunta F. Alkalinization of local anesthetics. Which block, which local anesthetic? Reg Anesth. 1995 Sep-Oct;20(5):369-77 15. McMorland GH, Douglas MJ, Jeffery WK, Ross PL, Axelson JE, Kim JH, Gambling DR, Robertson K. Effect of pH-adjustment of bupivacaine on onset and duration of epidural analgesia in parturients. Can Anaesth Soc J. 1986 Sep;33(5):537-41. 16. Khosa DS ,Thind SS ,Gupta SS ,Gupta HK Effects of addition of KCl of lignocaine and bupivacaine solutions on onset time and duration of brachial plexus block.Ind Journal of Anaesthesia 38;119;1990 17. Bromage PR, Burfoot MF. Quality of epidural blockade. II. Influence of physico-chemical factors; hyaluronidase and potassium. Br J Anaesth. 1966 Nov;38(11):857-65 18. Paris M R ,Chambers W A . Effects of addition of physiological concentration of potassium chloride to prilocaine and bupivacaine Br J Anaesth 58: 297:1986 19. Huxley AF ,Stampfli R Effect of potassium and sodium on resting and action potentials of single myelinated nerve fibers. J Physiol 1951 Feb;112(3-4):496-508. 20. H R Sweta Comparative study on the effect of addition of potassium chloride to bupivacaine on the onset time and duration of brachial plexus block. Journal of Evidence based Medicine and Healthcare Vol 1 ,Issue 16,Dec 22 2014 , 1989-2001Abstract
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