The effects of different doses of Morphine HCL added to Levobupivacaine on postoperative analgesia at supraclavicular brachial plexus blockade

Aim: In our study we aimed to research the effects of different doses of morphine HCI added to levobupivacaine on postoperative analgesia at supraclavicular 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 supraclavicular 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. 0,025mg/kg morphine HCl in the group II, and 0.05mg/kg morphine HCl in the group III was added to the same doses and volumes of levobupivacain. Blockade was applied with supraclavicular technique by the router of a peripheral nerve stimulator. After the application of technique, surgery starting time, sedation and analgesia levels (VAS,VRS) , 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, pain and horner syndrome.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. We suggested them to take orally tramadol HCl if the pain begins. At the 48th hour,pain starting time is asked and recorded. Datas were evaluated statistically by one way ANOVA and chi square test , p<0,05 values were accepted as significant.Findings: Demographic data and hemodynamic parameters were similar and statistically no significant difference is determined between the groups. Surgery starting time was 32.9 ± 9.4 minutes in group I, 24,0 ± 11,1 minutes in group II, 20,0 ± 7,8 minutes in group III . Statistically significant difference between three groups is determined (p<0,05) but no significant difference between group II and group III is determined (p>0,05). Statistically there was no significant difference between the groups for VAS, VRS and sedation values during peroperative and postoperative periods. (p>0,05). Postoperative pain starting times were 9,3 ± 2,8 hours in group I, 13,3 ± 1,5 hours in group II, and 16,6 ± 2,3 hours in group III. Statistically significant difference between group I and group II-groupIII (p<0.05) is determined but no significant difference between group II and group III is detected (p>0,05). Side effects such as nausea and vomitting, itch, breathing depression, pain and horner syndrome are not observed in any patients.Result: Consequently we found that an addition of morphine HCI 0,05 mg/kg and morphine HCI 0.025 mg/kg to %0,5 levobupivacain can obtain earlier surgery starting time and longer postoperative analgesia duration at supraclavicular brachial plexus blockade. However there was no difference between the doses of morphine HCI 0,025 mg/kg and morphine 0.05 mg/kg for surgery starting time and postoperative analgesia durationKey words: Levobupivacaine, Postoperative analgesia, Supraclavicular brachial plexus blockade, Morphine HCl,