Ketamine with Local Anesthetics Versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. There is a growing importance to the application of the ultrasound in clinical practice of anesthesia and regional nerve block especially in supraclavicular brachial plexus block. The idea of pre-emptively scanning patient’s anatomy for neurovascular variations or abnormalities has been suggested as a means of improving patient safety by preventing block complications such as pneumothorax, hematoma formation, improper block or intravascular injection.