Regional Anesthesia Clinical Trial
Official title:
Tramadol Versus Dexamethasone as Adjuvant to Levobupivacaine Under Ultrasound Guided Supraclavicular Block of Forearm Fractures
The investigator's aim will be to compare the efficacy of perineural tramadol and
dexamethasone added to levobupivacaine in prolonging postoperative analgesia in patient
undergoing open reduction and internal fixation for forearm fractures.
Primary outcome: duration of postoperative analgesia. Secondary outcome: include [The
anesthesia onset time, total rescue analgesic consumption in the 1st 24-hour and the presence
of complications and side effects.
Strategies to prolong brachial plexus nerve blocks analgesia beyond the pharmacological
duration of the local anaesthetic used include placement of indwelling perineural catheters
to allow prolonged infusion or the co-administration of adjuvants such as epinephrine, alpha
2 agonists (as clonidine and dexmedetomidine), midazolam, or the corticosteroid dexamethasone
.
Dexamethasone improves the quality and duration of peripheral nerve block over local
anaesthetic alone. This is thought to be mediated by attenuating the release of inflammatory
mediators, reducing ectopic neuronal discharge, and inhibiting potassium channel-mediated
discharge of nociceptive C-fibres .
Tramadol is a unique opioid with two modes of action for inhibition of pain, an opioid action
mediated by the μ receptor and a non-opioid action mediated by α-2-adrenergic and
serotoninergic activity .The monoaminergic activity of tramadol inhibits the descending pain
pathways, resulting in suppression of nociceptive transmission at the spinal level . Tramadol
also exhibits local anaesthetic properties by blocking K+ channels .Many studies have
characterized the effects of tramadol as an adjuvant to local anaesthetic in brachial plexus
block .
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