Effect of hyaluronidases added to different concentrations of bupivacaine on quality of ultrasound-guided supraclavicular brachial plexus block

Objective: To evaluate the efficacy of hyaluronidase as an adjuvant with volume reduction of bupivacaine in ultrasound-guided supraclavicular brachial plexus block for chronic renal failure patients. Design: Prospective double-blinded, randomized study Setting: tertiary institutional clinical care Patients, Participants: carried out on 60 patients with American Society of Anesthesiologists Classification (ASA) of physical status grade III with chronic renal failure with end-stage renal disease (ESRD) scheduled for elective surgery for arteriovenous shunt creation. Intervention: Both groups were US guided. In group I, patients received plain bupivacaine 0.5% (30 ml) by single-injection technique while in group II, patients received plain bupivacaine 0.5% (10 ml) plus 0.9% (5 ml) normal saline containing 500 IU (100 IU/ml) hyaluronidase. Main outcome (primary and secondary): The duration of sensory block, the onset of sensory and motor block, success rate, duration of motor block, total doses of intraoperative rescue analgesia, number of patients needed for postoperative rescue analgesia, and complications were recorded. Results: Hyaluronidase group had a significantly rapid onset of sensory and motor block than that of the bupivacaine group. On the other hand, both groups were similar in the duration of sensory block and motor block. Conclusion: Single injection technique was a sufficient modality of brachial plexus block. Hyaluronidase as an adjuvant to the local anesthetics has been fastened the onset of complete sensory block of ultrasound-guided supraclavicular brachial plexus blocks with minimal effect analgesic consumption postoperatively.