Continuous axillary brachial plexus block for postoperative pain relief. Intermittent bolus versus continuous...

Area of Science:

• Anesthesiology
• Pain Management
• Regional Anesthesia

Background:

• Postoperative pain management is crucial for patient recovery.
• Continuous axillary brachial plexus block is a common technique for analgesia.
• Comparing infusion versus intermittent injection methods is essential for optimizing drug delivery and safety.

Purpose of the Study:

• To compare the efficacy and safety of continuous axillary brachial plexus block via infusion versus intermittent injection of bupivacaine.
• To evaluate postoperative pain scores, motor block, and supplemental analgesic needs.
• To analyze plasma bupivacaine levels and identify potential toxicity concerns.

Main Methods:

• A prospective randomized trial involving 20 male patients undergoing microsurgery.
• Patients received 0.25% bupivacaine via an axillary brachial plexus catheter, either by continuous infusion or hourly intermittent bolus.
• Efficacy and plasma bupivacaine levels were monitored for up to 38 hours post-surgery.

Main Results:

• No significant differences were observed in pain scores, motor block, or narcotic requirements between the groups.
• Plasma bupivacaine levels were significantly higher in the continuous infusion group after 26 hours.
• No significant differences in cumulative bupivacaine doses or infusion rates were noted; complications were infrequent.

Conclusions:

• Both continuous infusion and intermittent bolus techniques provide safe and effective postoperative analgesia.
• Intermittent bolus administration of bupivacaine leads to lower plasma concentrations compared to continuous infusion.
• This suggests intermittent bolus may offer a safer pharmacokinetic profile for axillary brachial plexus block.