title: Perineural Nalbuphine in Ambulatory Upper Limb Surgery: A Comparison of Effects of Levobupivacaine with and without Nalbuphine as Adjuvant in Supraclavicular Brachial Plexus Block - A Prospective, Double-blinded, Randomized Controlled Study.
abstract: OBJECTIVE
  Various opioid additives have been trialed to prolong brachial plexus block. We evaluated the effect of adding nalbuphine hydrochloride to levobupivacaine for supraclavicular brachial plexus blockade. The primary end-points were the onset and duration of sensory and motor blocks and duration of analgesia.
  
  
  METHODS
  Seventy-eight patients (aged 25-45 years) posted for ambulatory forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Groups LN and LC) in a randomized, double-blind fashion. In Group LN (n= 39), 30 ml 0.5% levobupivacaine + 10 mg (diluted in 2 ml 0.9% saline) nalbuphine hydrochloride, and in Group LC (n= 39), 30 ml 0.5% levobupivacaine + 2 ml normal saline (0.9%) were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics, and side effects were recorded for each patient.
  
  
  RESULTS
  Although with similar demographic profile and block (sensory and motor) onset time, sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in Group LN (P< 0.05) than Group LC. Postoperative VAS value at 24 h was significantly lower in Group LN (P< 0.05). Intraoperative hemodynamics was comparable between two groups, and no any appreciable side effect was noted throughout the study period.
  
  
  CONCLUSIONS
  It can be concluded that adding nalbuphine hydrochloride to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects.
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Anjan
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Anaesthesiology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: RoyBasunia
authors.affiliation: Department of Anaesthesiology, N.R.S. Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Anindya
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Hirak
authors.initials: H
authors.lastname: Biswas
authors.affiliation: Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Rajasree
authors.initials: R
authors.lastname: Biswas
authors.affiliation: Department of Anaesthesiology, Murshidabad Medical College, Berhampore, West Bengal, India.
authors.forename: Tapobrata
authors.initials: T
authors.lastname: Mitra
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Surajit
authors.initials: S
authors.lastname: Chattopadhyay
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Subrata Kumar
authors.initials: SK
authors.lastname: Mandal
keywords: Levobupivacaine; nalbuphine hydrochloride; supraclavicular brachial plexus block