Comparison of 3 different bupivacaine concentrations used in the ultrasound guided infraclavicular brachial plexus block

Abstract

Objective: This double-blinded, randomized, prospective study compared 3 different concentrations of bupivacaine using the same total volume for ultrasound-guided infraclavicular block applied in the upper extremity surgery. Methods: This clinical trial was conducted on 150 patients aged between 18-65 years who underwent elbow, forearm, wrist, or hand surgery. The patients were equally and randomly distributed into three groups (n=50). Under ultrasound guidance, the first group received 20 mL of 0.5% bupivacaine, the second group 20 mL of 0.375% bupivacaine and the third group 20 mL of 0.25% bupivacaine injected into the brachial plexus cords. The onset time of sensory and motor block, surgical compliance time (SCT), motor block score at SCT, additional requirement for anesthetic and analgesic agents, sensory and motor block regression time, patient and surgeon satisfaction were recorded. Results: The onset of sensory block, motor block and SCT were significantly longer in the 0.25% bupivacaine group than the other groups (p=0.05). Motor block score at SCT was also lower in the 0.25% bupivacaine group. The earliest sensory-motor block regression time and requirement for analgesia were recorded in the 0.25% bupivacaine group. The patient and surgeon satisfaction was not different between groups. Conclusion: Although 0.25% bupivacaine concentration is disadvantageous as a result of this data, it can be preferred in patient groups in which full motor block is not wanted due to effective sensory blockade which is important for early postoperative motor examination and planning of physiotherapy.