Effect of Addition of Hyaluronidase as an Adjuvant to Lidocaine and Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Abstract Background Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post- operative pain control. Objective The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block. Methods This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month). Results There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 ± 47.97 mins, group B: 610.5 ± 57.9 mins) and motor (group A: 660.5 ± 47.29 mins, group B: 625.5 ± 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 ± 48.74 mins, group B: 618 ± 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 ± 1.56 mg). Conclusion This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block ….etc), the difference between the two groups was also significant statistically.