Effective post-operative pain control can reduce patient morbidity and affect the patient outcome. Brachial plexus block is one of them, a popular and widely employed regional nerve block technique for perioperative anesthesia and analgesia for surgery of the upper extremity. Different drugs have been used as adjuvants with local anesthetics in brachial plexus block to achieve quick, dense and prolonged block like Morphine, Pethidine, Clonidine, Dexmedetomidine. Naloxone is opioid antagonists which could selectively block the excitatory effects of opioids. it release endorphins and also displace endorphins from receptor site .it also reduce the opioid induced side effects, such as vomiting, nausea, pruritus, and respiratory depression.
The aim of this study is to evaluate the effect of ultra-low dose of naloxone when added to bupivacaine %.05 in supraclavicular brachial plexus block in orthopedic upper limb surgery and if it enhances the anti-nociceptive effect of post-operative opioid Effect of naloxone on anti-nociceptive criteria of post -operative opioid will be estimated by detecting the interval between each analgesic dose of post-operative opioid.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
64
Patients received 20 mL bupivacaine 0.5% plus 100 ng naloxone (1ml) in 2ml saline.(naloxone ampoule 0.4mg will dilute in 400ml of saline then 1ml of it will dilute in 10 ml saline, so each ml will have 100ng naloxone)
Patients will be injected ultrasound guided in their brachial plexus by 20 mL bupivacaine 0.5% plus 3 ml of saline
Mansoura University, Central Hospital, emergency Unit
Al Mansurah, Dakahlia Governorate, Egypt
Effect of ultra-low dose naloxone on the post operative opioid
by estimate the analgesic requirements of opioids and the interval between each opioid dose in 48 hour post operative
Time frame: for 48 hours after surgery
Duration of sensory block
will be defined as the time interval between the complete sensory block (complete absence of pinprick response) and first experience with postoperative pain
Time frame: For 48 hours after surgery
Duration of motor block
defined as the time interval between complete paralysis (Lovett rating scale = 0) and complete recovery (Lovett rating scale = 6)
Time frame: For 48 hours after surgery
Onset time of sensory block
defined as the time between the end of the last injection and complete absence of pinprick response in all nerve distribution
Time frame: For 48 hours after surgery
Onset time of motor block
defined as the time between the end of the last injection and complete paralysis (Lovett rating scale = 0) in all nerve distributions
Time frame: For 48 hours after surgery
Severity of post-operative pain
will be measured by visual analogue scale (VAS) where 0 was equal to no pain and 10 indicated the worst possible pain
Time frame: For 48 hours after surgery
1st time of analgesic request
First need for rescue opioid after surgery
Time frame: For 48 hours after surgery
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