The Effect of Adding Ketamine or Midazolam to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper Extremity Surgeries

Abstract
Background: The use of supraclavicular brachial plexus block is one of the most effective anesthetic techniques in operations for the upper extremity. The use of ultrasound guidance for regional anesthesia became popular owing to detection of anatomical variants, painless performance and correct needle placement. Aim of the study is to evaluate the value of adding ketamine or midazolam to bupivacaine when used for ultrasound guided supraclavicular brachial plexus block in upper extremity surgical procedures as regard the quality of surgical anesthesia and post-operative analgesia.
Patients and Methods: Seventy adult patients of both sexes aged (18-60) years with ASA physical status I/II sched-uled for elective surgical procedure of the elbow, forearm, wrist and hand. Patients divided into two groups thirty-five patients were given 30ml total volume of 0.5% bupivacaine with midazolam 50μg/kg injected around brachial plexus cluster (Group A) and thirty-five patients were given 30ml general volume contained 0.5% bupivacaine with ketamine 2mg/kg injected around brachial plexus cluster (Group B).
Results: There was no significant difference among both groups according to demographic data, hemodynamic changes, onset of motor and sensory block, sedation score, total doses of rescue analgesia and incidence of complications. There was significant prolongation in duration of sensory and motor block, significant decrease in VAS and significant delay in first request of rescue analgesia in Group A.
Conclusion: The addition of midazolam (50μg/kg) when used as adjuvants to bupivacaine in ultrasound guided brachial plexus block produced prolongation of sensory and motor block, providing desirable sedation, improved quality of postoperative analgesia and decreased necessities of rescue analgesics in post-operative period.