الفهرس 
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Abstract
Supraclavicular brachial plexus block is one of the most peripheral nerve blockades used for upper limb surgeries. It has many advantages over general anesthesia such as effective analgesia, awake patients, extended postoperative analgesia, with no airway manipulation and avoiding consequences of general anesthesia and Hemodynamic instability (Kumar A.Y and Agrawal M, 2016).
Many drugs like opioids, α agonists, steroids and vasoconstrictor agents have been co-administered in nerve blocks with local anesthetic agents to improve the block quality or
duration of analgesia. Although, many studies have shown an increase in success rate and duration of analgesia on addition of opioids in brachial plexus block, still the exact mechanism of action of opioids on peripheral nerves unclear (Brummett C.M and Williams B.A, 2011).
Aim of the work:
We evaluated the effect of addition of fentanyl to levobupivacaine on the onset, duration of the motor and sensory blocks and effect on postoperative analgesia in elective upper limb orthopedic surgeries.
Patients and methods:
After approval of research ethics committee of Sohag university hospital, a written consent was taken from all patients, any patient was informed about advantages and disadvantages of the research.
This double blinded randomized study was performed on Sohag university hospital on 100 patients aged between 18 and 60 years old with ASA score I or II posted for elective elbow, forearm and hand orthopedic surgeries using ultrasound guided supraclavicular brachial plexus block in the period between January 2019 and November 2019.
Study groups:
Patients were grouped into two groups, fifty patients in each group,
group L (control group) received Levobupivacaine 0.5% alone (22.5ml levobupivacaine + 7.5 ml normal saline).
group LF (study group) received levobupivacaine 0.5% with 50µg fentanyl (22.5 ml Levobupivacaine + 1 ml Fentanyl +6.5 ml normal saline).
Follow up and data collection:
- Monitoring of the heart rate, blood pressure, respiratory rate and oxygen saturation every 15 minutes during the intraoperative period and every 30 minutes for 6 hours postoperative.
- Onset of sensory block and motor block.
- Duration of sensory and motor block.
- Postoperative intensity of pain using VRS scale every 1 hour for 24 hours postoperative.
- Time for first analgesic inquiry.
- Number of times of analgesic inquiry.
- Incidence of complications.
Statical analysis:
The data will be compiled and will be subjected to statistical analysis using statistical package for social sciences (SPSS), demographic and hemodynamic data will be subjected to ANOVA-test and for statistical analysis of onset time and duration of sensory and motor blocks unpaired t-test will be applied and will be reconfirmed with the Wilcoxon W and Mann-Whitney U tests. P-value < 0.05 will be considered as statistically significant and P < 0.001 as highly significant. Any adverse effects will be analyzed using the chi-square / Fischer’s exact test.
Results:
Our study showed that there’s no significant difference between the studied groups regarding age, sex, duration of the operation or weight of the patients.
in our study, there was no hemodynamic changes on adding fentanyl to levobupivacaine except the heart rate was slightly lower on adding fentanyl.
Our study showed that adding fentanyl to levobupivacaine significantly reduces the onset of sensory block and motor block.
Also, adding fentanyl to levobupivacaine markedly prolongs the duration of the motor and sensory blocks.
Furthermore, addition of fentanyl to levobupivacaine lowered the VRS scale of patients in postoperative period producing marked postoperative analgesia.
This also prolonged the 1st analgesic inquiry time and reduced the analgesic requirements of the patients.
Conclusion
Using fentanyl as adjuvant to levobupivacaine is effective in enhancing onset of the brachial plexus block and prolonging the duration of motor and sensory blocks with no hemodynamic changes, it effectively prolongs postoperative analgesia and lowers the analgesic requirements.