الفهرس 
Table of Contents
BupivacaineOnly 14 pages are availabe for public view
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Abstract
This study was conducted on eighty patients with age ranging from 20 to 50 years old of either sex scheduled for unilateral forearm fractures for platting surgery, at Mansoura University Hospitals and Emergency Hospital using ultrasound guided supraclavicular brachial plexus block technique for intra-operative anesthesia and post-operative analgesia. Patients were randomly divided in o two equal groups, each group consisted of 40 patients. According to the mixture of anesthetic solution, patients were randomly assigned (sealed closed envelope) to one of the two equal groups; Bupivacaine group (group B) received 25 ml isobaric bupivacaine 0.5% plus 5 ml normal saline (total volume 30 ml). Bupivacaine-ketamine group(group BK) received 25 ml isobaric bupivacaine 0.5% plus ketamine 50mg (1 ml) plus 4ml normal saline (total volume 30 ml). Upon arrival in the preoperative regional block room, routine monitoring devices were placed and all patients administered midazolam 1-3mg IV for sedation 5 min before the procedure. Patients were positioned supine without a billow, arms at the side and the head tilted about 30 degrees to the contralateral side. A small roll was placed between the scapuulae to depress the shouldes. Data were collected in a work sheet special for each patient. Patient’s demographic data (name, age and gender), duration of operation, onset and duration of sensory and motor block, perioperative heart rate and mean arterial blood pressure, sedation score were recorded. Postoperative pain intensity was assessed by VAS. Successful block was defined as surgical anesthesia without the need for supplemental anesthetics or analgesics. In case of pain during surgery, a supplemental rescue nerve block was performed or intravenous analgesia with incremental i.v. fentanyl 50 µg was administered, and patient excluded from data analysis. Postoperative pain was recorded and treated by IM diclofenac sodium 75 mg on request. Number of rescue analgesia and time of 1st rescue analgesia were recorded.The Present study demonstrated no difference in onset and duration of sensory and motor block among patients of the two studied groups. It also revealed that ketamine enhances the analgesic effects of the brachial plexus block with less dose of rescue analgesics in post-operative 24 hours .There was significant difference of sedation score between the two groups at 30 and 60 min intraoperative observed in ketamine group. On arrival to PACU, there was no significant difference as all patients were alert.Both studied groups showed no significant difference regarding heart rate, and mean arterial blood pressure either intraoperative or postoperative. No major cardiovascular, respiratory or neurological complications observed in the two studied groups. from this study, we conclude that, the addition of ketamine to bupivacaine could be considered as an option to enhance the analgesic effects of the brachial plexus block with less dose of rescue analgesics in post-op 24 hours. Ketamine provides comfortable sedation intraoperatively without any need for airway assistance.