The effects of different doses of fentanyl added to levobupivacaine on postoperative analgesia at axillary brachial plexus blockade

ABSTRACTAim: In our study we aimed to research the effects of different doses of fentanyl added to levobupivacaine on postoperative analgesia at axillary brachial plexus blockade.Equipments and method: After the approval of faculty ethic committee and a writen informed consent taken from the patients, orthopedia patients who are going under upper extremity surgery and urology patients who are going under arteriovenous fistula surgery were taken in to the study and axillary brachial plexus blockade was applied to the totaly 60 patients. Patients randomly divided into three groups. To group I patients 0.5% levobupivacain in 40 ml volume was applied. 0.5 mcg/kg fentanyl in the group II, and 1mcg/kg fentanyl in the group III was added to the same doses and volumes of levobupivacain. Axillary blockade was applied by the router of USG. After the application of technique, surgery starting time, sedation and analgesia levels (VAS), preoperative, perioperative and postoperative hemodynamic parameters were recorded before the block and after the block at the 5, 10, 15, 30, 45, 60, 90, 120th minutes. The patients are observed during the operation and at the postoperative recovery room for the development of nausea and vomitting, itch, breathing depression and pain. We planned to give Ondansetron (4 mg) i.v. to the patients with nausea and vomitting. Postoperative second day we visited and asked the patients when their pain was started. At the 48th hour, pain starting time is asked and recorded. Datas were evaluated statistically by repeated measures analysis of varianceand chi square test, p<0.05 values were accepted as significant.Findings: Demographic data, BMI (body mass index) and age; grub III is higher than other groups and was found to be statistically significant (p<0.01). However, this situation is not important in the clinic and found that our application is not affected.Pharmaceutical dose and concentrations were applied fixed and standart to all our patients and an effective block achieved. Surgery starting time, hemodynamic parameters and postoperative pain starting times were similar and statistically no significant difference is determined between the groups. Statistically there was no significant difference between the groups for VAS and sedation values during peroperative and postoperative periods. (p>0.05). During sedation evaluation of postoperative patients, they were generally awake and calm, during clinical observation, there was tendency to fall asleep in one patient from group II and III. Side effects such as nausea and vomitting, itch are observed, however, breathing depression and pain are not observed in any patients. Nausea and vomiting were observed in one individual in group I (5%), in two individuals in groups II. and III (10%). No itching was observed in group I, while itching was seen in one individual in group II and in three individuals in group III.Result: 40 ml 0.5% levobupivacaine was applied in axillary brachial plexus blocks in group I, while 0.5 mcg/kg fentanyl was added to group II and 1 mcg/kg fentanyl was added to group III and concluded that there is no difference in time to onset of surgery, side effects and postoperative analgesic requirement times.Key words: Levobupivacaine, Postoperative analgesia, Axillary brachial plexus blockade, Fentanyl