Comparative evaluation of adding different opiates (morphine, meperidine, buprenorphine, or fentanyl) to lidocaine in duration and quality of axillary brachial plexus block

Saryazdi, Hamid; Yazdani, Alireza; Sajedi, Parvin; Aghadavoudi, Omid

Comparative evaluation of adding different opiates (morphine, meperidine, buprenorphine, or fentanyl) to lidocaine in duration and quality of axillary brachial plexus block

Authors

¹ Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There is no agreement about the effect of adding opioids to local anesthetics in peripheral nerve blocks. The aim of this study was to investigate the effect of adding different opioids with equipotent doses of lidocaine in axillary brachial plexus block using ultrasonography and nerve locator guidance.
Materials and Methods: In a prospective, randomized, double-blind clinical trial study, 72 adult patients aged 18-65 years old scheduled for orthopedic surgery of the forearm and hand with axillary brachial plexus block were selected and randomly allocated to four groups. Meperidine (pethidine), buprenorphine, morphine, and fentanyl with equipotent doses were added in 40cc of 1% lidocaine in P, B, M, and F groups, respectively. The onset and duration of sensory and motor blocks, severity of patients' pain, duration of analgesia, hemodynamic and respiratory parameters, and adverse events (such as nausea and pruritus) during perioperative period were recorded.
Results: The onset time for the sensory block was similar in the four groups. The onset time for the motor block was significantly faster in morphine and pethidine groups (P = 0.006). The duration of sensory and motor blocks was not statistically different among the four groups. The quality of motor blockade was complete in 100% of patients receiving pethidine or morphine and 77.8% of patients receiving buprenorphine or fentanyl (P = 0.021).
Conclusion: In the upper extremity surgeries performed under axillary brachial plexus block addition of morphine or pethidine to lidocaine may be superior to other opioids (i.e. fentanyl and buprenorphine) due to better quality and quantity of motor blockade and faster onset of the block.

Keywords

References

1.	Russon K, Pickworth T, Harrop-Griffiths W. Upper limb blocks. Anaesthesia 2010;65 Suppl 1:48-56.
2.	Koscielniak-Nielsen ZJ, Dahl JB. Ultrasound-guided peripheral nerve blockade of the upper extremity. Curr Opin Anaesthesiol 2012;25:253-9.
3.	Nadeau MJ, Lévesque S, Dion N. Ultrasound-guided regional anesthesia for upper limb surgery. Can J Anaesth 2013;60:304-20.
4.	Nockemann D, Rouault M, Labuz D, Hublitz P, McKnelly K, Reis FC, et al. The K(+) channel GIRK2 is both necessary and sufficient for peripheral opioid-mediated analgesia. EMBO Mol Med 2013;5:1263-77.
5.	Gupta A, Bodin L, Holmström B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesth Analg 2001;93:761-70.
6.	Ammar AS, Mahmoud KM. Ultrasound-guided single injection infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for pain control in upper limb surgery: A prospective randomized controlled trial. Saudi J Anaesth 2012;6:109-14. [PUBMED]
7.	Shrestha BR. Nerve stimulation under ultrasound guidance expedites onset of axillary brachial plexus block. J Nepal Health Res Counc 2011;9:145-9.
8.	Wedel DJ, Horlocker TT. Nerve blocks. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronishet JP, Young WL, editors. Miller's Anesthesia. 7 ^th ed. United States of America: Churchill Livingstone; 2010. p. 1671.
9.	Gray AT. Ultrasound guidance for regional anesthesia. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronishet JP, Young WL, editors. Miller's Anesthesia. 7 ^th ed. United States of America: Churchill Livingstone; 2010. p. 1690.
10.	Hurley RW, Wu CL. Acute postoperative pain. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronishet JP, Young WL, editors. Miller's Anesthesia. 7 ^th ed. United States of America: Churchill Livingstone; 2010. p. 2774.
11.	Stein C, Lang LJ. Peripheral mechanisms of opioid analgesia. Curr Opin Pharmacol 2009;9:3-8.
12.	Fletcher D, Kuhlman G, Samii K. Addition of fentanyl to 1.5% lidocaine does not increase the success of axillary plexus block. Reg Anesth 1994;19:183-8.
13.	Karakaya D, Büyükgöz F, Baris S, Güldogus F, Tür A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med 2001;26:434-8.
14.	Nishikawa K, Kanaya N, Nakayama M, Igarashi M, Tsunoda K, Namiki A. Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Anesth Analg 2000;91:384-7.
15.	Bouaziz H, Kinirons BP, Macalou D, Heck M, Dap F, Benhamou D, et al. Sufentanil does not prolong the duration of analgesia in a mepivacaine brachial plexus block: A dose response study. Anesth Analg 2000;90:383-7.

Advanced Biomedical Research