Fentanyl and Dexamethasone as Adjuvants to Bupivacaine-Lidocaine in Landmark-Guided Supraclavicular Brachial Plexus Block: A Comparative Study in Bangladesh
Keywords:
Supraclavicular brachial plexus block, Bupivacaine-lidocaine, Fentanyl, Dexamethasone, Postoperative analgesiaAbstract
Background: Supraclavicular brachial plexus block is an effective regional anesthetic technique for upper-limb surgery, but the short duration of local anesthetics remains a limitation. Dexamethasone and fentanyl may improve block quality and prolong analgesia, though evidence on their combined use in landmark-guided block is limited in Bangladesh. Aim of the study: This study compared the efficacy of bupivacaine-lidocaine alone with bupivacaine-lidocaine plus fentanyl and dexamethasone in landmark-guided supraclavicular brachial plexus block. Methods: This retrospective comparative study was conducted in the Department of Anesthesiology, Gazi Medical College Hospital, Khulna, Bangladesh, from January to December 2025. Hospital records of 60 adult patients undergoing upper-limb surgery under landmark-guided supraclavicular brachial plexus block were reviewed, with 30 patients in each group. Group A received bupivacaine-lidocaine, while Group B received bupivacaine-lidocaine with fentanyl and dexamethasone. Data on block characteristics, analgesic duration, pain scores, hemodynamic parameters, and complications were collected from perioperative records. Results: Baseline and block performance characteristics were comparable between the groups. Compared with Group A, Group B showed a faster onset of sensory block (7.1±1.9 vs 9.8±2.4 minutes) and motor block (10.9±2.5 vs 14.6±3.1 minutes). Group B also had significantly longer duration of sensory block (332.6±21.4 vs 218.4±16.7 minutes), motor block (287.9±18.6 vs 194.7±15.3 minutes), and analgesia (356.4±19.7 vs 236.2±14.8 minutes), with p<0.001 for all. The need for supplementary intraoperative analgesia was lower in Group B (3.3% vs 20.0%). Fewer patients in Group B required rescue analgesia within 24 hours (60.0% vs 86.7%), and the time to first rescue analgesia was longer (348.7±22.6 vs 228.4±16.9 minutes). Hemodynamic parameters were comparable between the groups, and no major complications were observed. In addition, Group B had better block quality and higher patient satisfaction scores (8.8±1.0 vs 7.1±1.3). Conclusion: The addition of fentanyl and dexamethasone to bupivacaine-lidocaine in landmark-guided supraclavicular brachial plexus block provided faster block onset, prolonged analgesia, reduced postoperative pain and rescue analgesic requirement, and improved patient satisfaction, without major complications compared to bupivacaine-lidocaine alone.
Mediscope 2026;13(2): 69-76
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Copyright (c) 2026 Gaitri Kashyapi, Abhijit Mondol, Saddam Hossain, Murad Hossain
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