Bupivacaine with or without neostigmine for ultrasound-guided supraclavicular brachial plexus block in forearm and hand surgeries

Background Peripheral nerve blocks offer superior anesthesia for upper limb surgeries, providing effective pain control with minimal systemic side effects. Among these, the supraclavicular brachial plexus block is particularly advantageous for surgeries involving the forearm and hand due to its proximity to the brachial plexus trunks, ensuring quick onset and high success rates. To further enhance the efficacy of local anesthetics, various adjuvants have been explored. Neostigmine, a cholinesterase inhibitor, has shown promise in prolonging block duration without central side effects when used peripherally. This study evaluates the effects of adding neostigmine to bupivacaine for ultrasound-guided supraclavicular block. Aim The primary objective was to compare the onset and duration of sensory and motor blocks using bupivacaine alone versus bupivacaine with neostigmine. Secondary objectives included assessing hemodynamic changes, block-related complications, patient satisfaction, and surgical anesthesia success rates. Patients and methods This prospective, randomized, double-blinded controlled study enrolled 30 adult patients (American Society of Anesthesiologists physical status I or II) undergoing forearm and hand surgeries at Alexandria Main University Hospital. Patients were randomized into two groups: group A received 20 ml of 0.5% bupivacaine with saline, and group B received 20 ml of 0.5% bupivacaine with 0.5 mg of neostigmine. Both blocks were performed under ultrasound guidance. Exclusion criteria included contraindications to nerve blocks, opioid dependence, vascular injury, and respiratory risks. Results Statistical analysis of the data revealed that group B demonstrated significantly faster onset times and longer durations for both sensory and motor blocks compared with group A. Hemodynamic changes were minor, with transient increases in heart rate and mean arterial pressure in group B. Surgical anesthesia success rates were high in both groups, and no significant difference was observed in patient satisfaction. Complications were minimal, with only one instance of paraesthesia reported. Conclusion The addition of neostigmine to bupivacaine significantly improves the onset and prolongs the duration of sensory and motor blocks for supraclavicular brachial plexus anesthesia, with minimal hemodynamic impact and a low complication rate. These findings support the use of neostigmine as a valuable adjuvant in regional anesthesia. Further studies are recommended to refine dosing strategies and enhance patient outcomes.