The Efficacy of Fentanyl as An Adjunct to Vertical Infraclavicular Brachial Plexus Block Performed with Lidocaine and Bupivacaine

Background and objective: Different opioids have been added to local anaesthetics in the attempt to enhance the quality of anaesthesia and analgesia of the brachial plexus block. Our aim was to evaluate the effect of fentanyl on the quality of nerve block after vertical infraclavicular brachial plexus block and on the postoperative analgesia.Methods: In this prospective, randomized, double blind and controlled study, 60 adult patients received a mixture of 30 ml of 1% lidocaine with adrenaline 1: 200000 and 10 ml of 0.5% bupivacaine. The Fentanyl group (n=30) received fentanyl 1^g kg-1 diluted up to 5 ml of 0.9% saline. The control group (n=30) received 5 ml of 0.9% saline.We evaluated the sensory block at 5, 10, 15 and 30 minutes and the motor block at 30 minutes after injection of the anaesthetic agents. The postoperative analgesia was recorded for the first 24 hours from the time immediately after injection of the anaesthetic agents.Results: Two patients in group F and 3 patients in group C were excluded because of unsuccessful blockade. The loss of sensation of the radial nerve in group F at 5, 10, 15 and 30 minutes was significantly faster compared with group C (P 0.001). Otherwise, there was no difference between the two groups on both sensory and motor blocks (P 0.05). The duration of postoperative analgesia was slightly longer in the Fentanyl than in the control group, mean (10.3 h ± 2.4 vs. 9.4 h ± 2.5) with no statistical significance (P 0.05).Conclusion: The addition of fentanyl 1ug kg-1 to local anaesthetic mixture prolongs the duration of postoperative analgesia but does not provide clear benefits regarding the onset of sensory and motor block.