Fentanyl versus tramadol as an adjunct to bupivacaine in ultrasound-guided supraclavicular brachial plexus blockade: pros and cons

Background & objective: There have been a lack of consensus among the anesthetists regarding the utility of different opioids as adjuvants in brachial plexus blockade (BPB). The results vary and there is no agreement. We studied the utility of fentanyl versus tramadol as an adjunct to local anesthetic bupivacaine in ultrasound-guided supraclavicular BPB. Methodology: The study was conducted on 71 patients who were randomized in three groups for ultrasound-guided supraclavicular brachial plexus block. Group B: received 20 ml bupivacaine 0.5% plus normal saline 2 ml; Group F received 20 ml of bupivacaine 0.5% plus fentanyl 100 μg in 2 ml and Group T received 20 ml bupivacaine 0.5% plus tramadol 100 mg in 2 ml. Data was collected for the onset and duration of sensory and motor block, time to first request for rescue analgesia and the total analgesic consumption in first 24 h postoperatively. Results: The onset of sensory blockade in Group T (8.36 ± 1.59 min) was significantly shorter compared to Group B [15.91 ± 3.21 min (p = 0.011)] and to Group F [10.64 ± 1.86 min (p = 0.011)]. The onset of motor blockade was also shorter in Group T (10.36 ± 1.92) compared to Group B [20.91 ± 3.22 min (p = 0.001)] and Group F [13.36 ± 1. 29 (p = 0.001) respectively. The time to first analgesic requests was significantly longer in the Groups T and F than in the Group B (p = 0.001 and p = 0.021, respectively) and significantly longer in the tramadol group compared to the fentanyl group (p = 0.041). Conclusion: Tramadol as an adjuvant to bupivacaine in ultrasound-guided supraclavicular BPB, when compared to bupivacaine alone or with fentanyl, has a shorter onset of sensory and motor blockade and produces a significantly prolonged analgesia. Key words: Adjuvants; Analgesia; Bupivacaine; Fentanyl; Tramadol; Ultrasound-guided supraclavicular blockAbbreviations: BPB – brachial plexus blockade; VAS – visual analog scale; MBP – mean blood pressure; HR – heart rate; SpO2 – peripheral oxygen saturation; LSD – test Least Significant Difference test Citation: Ghazaly HF, Eldemrdash AM, Atito BE, Abdelrheem SS, Aly AAA. Fentanyl versus tramadol as an adjunct to bupivacaine in ultrasound-guided supraclavicular brachial plexus blockade: pros and cons. Anaesth. pain intensive care 2021;25(4):450–457. DOI: 10.35975/apic.v25i4.1565 Received: March 17, 2021. Reviewed: May 23, 2021. Accepted: June 17, 2021