The efficacy of adjuvants to bupivacaine in ultrasound-guided supraclavicular block: a comparative study between dexmedetomidine, ketamine, and fentanyl

Background Ultrasound-guided supraclavicular block is of increasing importance in upper limb surgeries as it provides excellent pain control and reduced side effects. The search for the ideal adjuvant is still present. In this study, we aim to evaluate the efficacy and safety of dexmedetomidine, ketamine, and fentanyl when added to bupivacaine in ultrasound-guided supraclavicular block. Patients and methods A total of 60 patients with American Society of Anesthesiologists (ASA) I and II scheduled for upper limb surgeries were randomly assigned into three groups (20 patients each): group DB received 38 ml bupivacaine 0.5% with 2 ml (100ug) dexmedetomidine. Group KB received 38 ml bupivacaine 0.5% with 2 ml (100 mg) ketamine. Group FB received 38 ml of bupivacaine 0.5% with 2 ml (100ug) fentanyl. We measured sensory/motor block, sedation level, adverse effects, the total amount of rescue analgesia, and post-operative pain. Results There was a significant increase in the duration of sensory and motor block in the DB group with no difference in the onset. The mean blood pressure and heart rate were lower in the DB group. Analgesic effects of dexmedetomidine were higher, followed by ketamine and lastly fentanyl. Post-operatively visual analogue scale (VAS) and rescue analgesia results indicated that dexmedetomidine and ketamine provided adequate post-operative analgesia. Conclusion Addition of dexmedetomidine was more effective in prolongation of the sensory and motor duration as well as providing adequate intra-operative analgesia when compared to ketamine and fentanyl. Dexmedetomidine and ketamine are effective and safe in post-operative analgesia.