Non-opioid analgesia with Regional block: The effect of ketamine as adjuvant with 0.5% bupivacaine in infraclavicular brachial plexus block


Aims: To determine the effect of the addition of 25 µg/kg body weight ketamine to 0.5% bupivacaine in infra-clavicular brachial plexus block. Patients and Methods: In a randomized double blinded, placebo controlled clinical trial, Forty patients, from the age of 20-60 years, with ASA I, II and III, undergoing upper limb (below elbow) surgery, had been chosen to be enrolled in the study. They had been divided randomly, into 2 groups. Group 1 will receive 30 ml of solution 1 (25 ml of 0.5% bupivacaine with 5 ml of normal saline) as placebo or control group. Group 2 will receive 30 ml of solution 2 (25 ml of 0.5% bupivacaine with 25 µg/kg body weight ketamine) as ketamine group. A nerve stimulator (B/Braun Stimuplex® HNS 11) had been connected to 22G-10 cm length insulated needle. Time of motor impairment was assessed by lack of muscular coordination and heaviness feeling of the limb. Time of parasthesia was assessed by loss of pin brick sensation.Results: There was a quite noticeable prolonged time of analgesia in the ketamine group. The mean ± SD was 698 ± 139 minutes in ketamine group while the mean ± SD in placebo group was 140 ± 40 minutes (p<0.05). Twelve patients out of 20 had recorded 800 minutes of analgesia (60%) in ketamine group. There were no other clinical differences in side effects or motoric latency in between both groups. Conclusions: Low dose of ketamine added as an adjuvant to 0.5% bupivacaine in infra-clavicular brachial plexus block, will prolong the time of post-operative analgesia without any side effects.