The Observational Study of Effects of Bupivacaine And Ropivacaine in Patients Undergoing Both Bone Fracture Surgeries Under Axillary Brachial Plexus Block

Abstract

Background: Axillary brachial plexus block is an established regional anaesthetic technique for upper-limb surgery. Bupivacaine and ropivacaine are long-acting local anaesthetic agents with differences in their onset and duration of sensory and motor blockade. The present study compared the clinical characteristics of 0.5% bupivacaine and 0.75% ropivacaine in patients undergoing both-bone forearm fracture surgery under axillary brachial plexus block.

Materials and Methods: This observational study was conducted in the Department of Anaesthesiology at Saveetha Medical College and Hospital, Chennai, over a period of six months in 2023. A total of 40 patients aged 18–55 years, belonging to ASA physical status I or II and scheduled for both-bone fracture surgery under axillary brachial plexus block, were included. Patients were divided into two groups of 20 each. Group B received 0.5% bupivacaine, while Group R received 0.75% ropivacaine. Sensory and motor block characteristics were assessed, including onset and duration of blockade. Perioperative heart rate, systolic blood pressure and diastolic blood pressure were recorded. Postoperative pain was assessed using the Visual Analogue Scale, and the time to first rescue analgesia was documented.

Results: The baseline demographic characteristics were comparable between the groups. The mean onset of sensory block was significantly shorter with ropivacaine than with bupivacaine (6.10 ± 1.13 vs. 14.85 ± 2.49 minutes; p<0.0001). Similarly, the onset of motor block was significantly faster with ropivacaine (9.00 ± 1.18 vs. 22.70 ± 2.79 minutes; p<0.0001). The duration of sensory blockade was significantly longer with ropivacaine (489 ± 54.58 vs. 399 ± 63.71 minutes; p<0.0001), whereas the duration of motor blockade was significantly longer with bupivacaine (498 ± 54.00 vs. 441 ± 63.71 minutes; p=0.0041). The mean time to first rescue analgesia was significantly longer in the ropivacaine group (720 ± 61.64 vs. 624 ± 33.22 minutes; p<0.0001). Heart rate and systolic blood pressure remained comparable between the groups at the assessed time points, while a significant difference in diastolic blood pressure was observed only at 5 minutes.

Conclusion: Both 0.5% bupivacaine and 0.75% ropivacaine provided effective axillary brachial plexus blockade for both-bone forearm fracture surgery with overall stable perioperative haemodynamic parameters. Ropivacaine demonstrated a faster onset of sensory and motor blockade, longer sensory blockade and a longer duration before first rescue analgesia, whereas bupivacaine produced a longer duration of motor blockade. These differences may be considered when selecting the local anaesthetic according to the desired sensory and motor block characteristics.