American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2016, 4(10), 336-338
DOI: 10.12691/ajmcr-4-10-2
Open AccessArticle

Ultra-low Dose Naloxone Added to 0.5% Bupivacaine Significantly Prolongs the Duration of Analgesia Following Supraclavicular Brachial Plexus Block

Amal A M Al-Shukaili1, , Khoula M S AL-Mandhari1, Basman Younis1, Shobha Lad1, Awadh Othman1 and Sachin Jose2

1Department of Anesthesia & ICU, Khoula Hospital, Muscat, Sultanate of Oman

2Oman Medical Specialty Board, Muscat, Sultanate of Oman

Pub. Date: October 29, 2016

Cite this paper:
Amal A M Al-Shukaili, Khoula M S AL-Mandhari, Basman Younis, Shobha Lad, Awadh Othman and Sachin Jose. Ultra-low Dose Naloxone Added to 0.5% Bupivacaine Significantly Prolongs the Duration of Analgesia Following Supraclavicular Brachial Plexus Block. American Journal of Medical Case Reports. 2016; 4(10):336-338. doi: 10.12691/ajmcr-4-10-2

Abstract

In this prospective, randomized, double-blind study, we evaluated the effect of ultra-low dose of naloxone on duration of supraclavicular brachial plexus block. It was hypothesized that naloxone can prolong the duration of sensory block. Following approval by Hospital Ethical Issues Committee, eighty patients scheduled for upper limb surgery under supraclavicular brachial plexus block were randomly allocated into control group who received 20ml bupivacaine with 3 ml normal saline (Group B) or study group that received 20ml bupivacaine with 100 mcg. of naloxone in 3 ml saline, (Group BN). Onsets of sensory and motor blockade were assessed at an interval of 3 min following the block. Duration of sensory and motor block was considered to be the time interval between the complete block and the first post operative pain reported by patient and complete recovery of motor functions respectively. The difference in onset time for sensory and motor block was statistically significant between two groups but clinically it may be considered insignificant. The recovery of sensory block was slower in group BN (15.6 ± 3.2 hr) compared to group B (13.3 ± 2.4 hr) [p=0.0001]. The recovery of motor block was slower in group B (13.3 ± 2.5 hr) compared to group BN (11.6 ± 4.3) [P=0.03]. In conclusion, addition of ultra-low dose of naloxone to bupivacaine in supraclavicular block prolongs the duration of sensory block and reduces duration of motor block significantly as compared to bupivacaine alone.

Keywords:
supraclavicular block naloxone bupivacaine ultrasound guidance

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References:

[1]  Kapral S, Krafft P, Eibenberger K,Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994; 78: 507-513.
 
[2]  Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg 2003; 97: 1518-1523.
 
[3]  Movafegh A, Razazian M, Hajimohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg 2006; 102: 263-267.
 
[4]  Ali M, Behrang N, Mustafa S, Omid N. An ultra-low dose of Naloxone added to lidocaine or lidocaine-fentanyl mixture prolongs axillary brachial plexus blockade. Anesth Analg 2009;109:1679-1683.
 
[5]  Gan TJ,Ginsberg B, Glass PS, Fortney J, Jhaveri R, Perno R. Opioid-sparing effect of a low-dose infusion of naloxone in patient-administered morphine sulfate Anesthesiology 1997; 87: 1075-1081.
 
[6]  Cole DJ, Drummond JC, Shapiro HM, Hertzog RE, Brauer FS.The effect of fentanyl anesthesia and intrathecal naloxone on neurologic outcome following spinal cord injury in the rat. Anesthesiology 1989; 71:426-430.
 
[7]  Sinz EH, Kofke WA, German RH. Phenytoin, midazolam and naloxone protect against fentanyl induced brain damage in rats. Anesth Analg 2000; 91:1443-1449.
 
[8]  Acalovschi I, Cristea T. Intravenous regional anesthesia with meperidine. Anesth Analg 1995;81:539-543.
 
[9]  Marashi SM, Sharifnia HR, Azimaraghi O, Aghajani Y, Barzin G, Movafegh A. Naloxone added to bupivacaine or bupivacaine-fentanyl prolongs motor and sensory block during supraclavicular brachial plexus blockade. ActaAnaesthScand 2015; 59: 921-7.
 
[10]  Levine JD,Gordon NC. Method of administration determines the effect of naloxone. Brain Res 1986;365:377-378.
 
[11]  Levine JD,Gordon NC, Fields HL. Naloxone dose dependently produces analgesia and hyperalgesia in postoperative pain. Nature 1979;278:740-741.
 
[12]  Tsai RY,Tai YH, Tzeng JI,Lin SL, Shen CH, Yang CP,et al. Ultra-low dose naloxone restores the anti-nociceptive effect of morphine in pertussis toxin-treated rats and prevents glutamate transporter down-regulation by suppressing the p38 mitogen-activated protein kinase signaling pathway. Neuroscience 2009;159:1244-1256.