Comparison of Anaesthetic efficacy of Ropivacaine and Ropivacaine with Nalbuphine as an adjuvant for Ultrasound guided Supraclavicular Brachial plexus blockade: A Randomized Controlled trial

Ropivacaine is a long-acting regionalanesthetic that is structurally related to bupivacaine. It is a S(−)enantiomer, unlike bupivacaine, which is a racemate and  well-established long-acting regionalanesthetic, which like all amide anesthetics has been associated withcardiotoxicity when used in high concentration or when accidentallyadministered intravascularly. Hence ropivacaine was developed for the purposeof reducing potential toxicity and improving relative sensory and motor blockprofiles. Various adjuvants have been added to local anesthetics in brachialplexus block to achieve quick, dense, and prolonged block; however, the resultsare either inconclusive or associated with side effects.

Nalbuphine, a derivative of14-hydroxymorphine, is an agonist-antagonist opioid acting on µ (mu) receptorsas antagonist and κ (kappa) receptors as agonist with an analgesic potencyequal to morphine and its antagonistic potency is approximately ¼th ofthat of naloxone. Unlike morphine, it exhibits a ceiling effect on respiratorydepression. Nalbuphine has the potential to maintain or even enhanceµ-opioid-based analgesia while simultaneously mitigating the µ-opioid sideeffects.Therefore the purpose of this study is to compare by adding nalbuphine withropivacaine in supraclavicular brachial plexus block and to know its efficacy.