Efficacy comparison of magnesium sulphate, ketamine and neostigmine adjuvants to bupivacaine 0.5% on onset, duration and quality of ultrasound-guided supraclavicular block characteristics for forearm surgery

Introduction: This study aimed to provide an evidence-based foundation for appraising the efficacy of magnesium sulphate, ketamine and neostigmine plus bupivacaine 0.5% on key supraclavicular block (SCB) characteristics made up of onset, duration and quality for forearm surgery. Materials and Methods: This double-blind trial enrolled ninety patients who were identified as having needed forearm surgery and been hospitalised in the Arak-based Valiasr Hospital, Iran, stratified participants into triad randomised groups receiving the aforementioned adjuvants. The basic requirements were met to incorporate the underneath groups' data to be recorded and analysed within SPSS release 20: (a) haemodynamic parameters (including mean arterial pressure/heart rate/oxygen saturation) documented at 5-min intervals until the end of surgery; (b) the onset and next to the duration of complete sensory and motor block, the time to administration of the patient's first post-operative analgesia and the overall dose of analgesic administered; (c) all block failures; (d) opioid consumption during post-operative 24 h and (e) pain score measured on a visual analogue scale throughout recovery time and scheduled post-operative times (2, 4, 8, 12 and 24 h). Results: Notwithstanding the shorter onset of sensory and motor block manifested in the magnesium sulphate group and longer duration of motor block in those receiving neostigmine regimen (P < 0.001), the findings endorsed strong support for the potential efficacy of ketamine in affording the longer duration of sensory block, better clinically meaningful pain relief at all scheduled times and diminished opioid consumption during 24 h (all P < 0.001). Conclusion: Bearing in mind the lack of complication needing to be thought of and the trial's clinical findings, which bespeak the shorter onset of the block (both sensory and motor) in the group receiving magnesium sulphate versus the longer duration of motor and sensory block in the neostigmine- and ketamine-treated groups, respectively, and diminished pain score and opioid consumption in the latter, all the adjuvants, thus, could be suggested to be contributed to achieving successful SCB in forearm fracture patients, depending on the patient's general condition and the anaesthesiologist's discretion.