A Comparative Study of Analgesic Effectiveness between Tramadol Plus Levobupivacaine versus Fentanyl Plus Levobupivacaine in Ultra Sound Guided Supraclavicular Brachial Plexus Block

Introduction: The brachial plexus block is a frequently utilized nerve plexus block for providing perioperative anaesthesia and pain relief during upper limb surgeries. Levobupivacaine, an S (-) enantiomer of bupivacaine and part of the amino-amide group, has a favourable clinical profile with a better safety margin for cardiovascular and central nervous system effects. To improve the effectiveness of supraclavicular brachial plexus blocks, adjuvants like tramadol, fentanyl, dexamethasone, and butorphanol are added to local anaesthetics. The study was conducted to compare the analgesic effectiveness between Tramadol plus Levobupivacaine versus Fentanyl plus Levobupivacaine in ultra sound guided supraclavicular brachial plexus block.” Methods: The present prospective, observational, and comparative study was conducted in the Department of Anaesthesiology at a tertiary care hospital, from January 1, 2023, to June 30, 2024 amongst 100 patients, aged 18 to 70 years, who were scheduled for elective upper limb surgeries. They were randomly assigned into two equal groups (Group I and Group II) using the Complete Enumeration method, with 50 patients in each group. Group I – This group of patients received inj. 0.5% Levobupivacaine 20 mL + Fentanyl 100mcg(2mL) + NS making a total of 30 ml. Group II – This group of patients received inj. 0.5% Levobupivacaine 20 mL + Tramadol 100 mg (2 mL) + NS making a total of 30 ml. Results: For onset of sensory block the tramadol group exhibited a mean onset time of 11.92 ± 1.957 minutes, while the fentanyl group had a significantly shorter sensory block onset time of 3.80 ± 0.990 minutes. For onset of motor block the tramadol group showed a mean onset time of 11.78 ± 1.941 minutes, while for onset of motor block the fentanyl group had a notably shorter onset time of 4.48 ± 0.886 minutes. The total duration of motor block in the tramadol group had a mean duration of 461.80 ± 27.15 minutes, whereas the fentanyl group had a shorter total duration of motor block of 369.80 ± 16.22 minutes. Both tramadol and fentanyl are effective in inducing sensory and motor blocks, fentanyl demonstrates a faster onset of action, whereas tramadol provides a longer duration of block. While some fluctuations were noted, overall, tramadol and fentanyl groups maintained comparable MAP values for most of the study duration. Conclusion: The present study concludes that despite differences in the onset and duration of sensory and motor blocks, both tramadol and fentanyl showed comparable effects on patient demographics and cardiovascular stability.