Effect of Ketamine Supplementation in Axillary Plexus Blockade: A Comparative Study

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Axillary brachial plexus block is a standard regional anesthesia for below-elbow procedures.
• Adjuvants can modify block characteristics and postoperative pain.
• Ketamine's role as an adjuvant in brachial plexus blocks requires further clarification.

Purpose of the Study:

• To compare the effects of intravenous ketamine versus regional ketamine, combined with ropivacaine, versus ropivacaine alone.
• To evaluate the impact on postoperative analgesia, rebound pain, and block onset times.
• To assess the need for rescue analgesia and adverse effects within 24 hours.

Main Methods:

• Randomized, prospective, single-blind comparative study.
• Ultrasound-guided axillary brachial plexus block for below-elbow surgery.
• Three groups: ropivacaine alone, intravenous ketamine + ropivacaine, regional ketamine + ropivacaine.

Main Results:

• Both intravenous and regional ketamine groups showed faster block onset (p<0.0005).
• Significantly lower pain scores (NRS) were observed at 16, 20, and 24 hours post-surgery compared to control (p=0.049 to p=0.006).
• No significant differences in motor block scores or opioid consumption were found between groups.

Conclusions:

• Intravenous and regional ketamine equally enhance postoperative analgesia when added to ropivacaine.
• Ketamine addition attenuates rebound pain and reduces sensory/motor block onset time.
• Further high-quality research is recommended to fully understand ketamine's role in axillary brachial plexus blocks.