The Effectiveness of Articaine in Brachial Plexus Blockade: A Prospective Randomized Trial

BACKGROUND: Articaine has become widely used for infiltration and conduction anesthesia in dentistry, but there are still few studies on its use for regional blockades during limb surgery.

AIM: To assess the development and duration of sensory and motor blockade during regional anesthesia with articaine compared with ropivacaine during operations on the upper limb.

METHODS: A single-center prospective randomized trial was conducted. 60 patients operated on the upper extremities under regional anesthesia were included. The patients were randomized into groups: Group 1 (n=30) with the use of 2% articaine solution for blockade, Group 2 (n=30) — 0.5% ropivacaine solution. The groups were divided into subgroups (n=15) depending on the blockade of the interlobular or axillary access. The primary point of the study was the assessment of the development of sensory and motor blocks. The secondary points were the duration of the blockade, the frequency of side effects (nausea/vomiting, hypotension, bradycardia, dizziness).

RESULTS: When examining the characteristics of sensory blockade 30 minutes after administration of the anesthetic, statistical differences were found only in the rate of development of the blockade. The use of articaine led to a more rapid development of the sensory block in both the intercellular [in Group 1 7.0±2.9 min, in Group 2 10.0±3.1 min (p=0.015)] and axillary blockade [in Group 1 8.0±2.1 min, in Group 2 12.0±4.2 min (p=0.02)]. In case of interlateral blockade, the absence of movement in the shoulder area was achieved in 12 (80%) patients of group 1, and in 13 (86.7%) of group 2. With axillary block, flexion in the fingers was absent in 8 (53.3%) in group 1 and in 9 (60%) patients in group 2 (p=0.117). The duration of sensory blockade (12.1±5.4 hours vs. 3.1±0.5 hours, p=0.001), motor blockade (5.3±2.2 hours vs. 2.2±0.8 hours, p=0.016) by interlobular access and sensory blockade (10.3±3.2 hours vs. 2.8±0.7 hours, p=0.001), motor blockade blockade (4.9±1.4 hours vs. 1.7±0.4 hours, p=0.02) by axillary access was greater in patients in the ropivacaine group than in the articaine group. According to the frequency of complications, hoarseness of the voice was more common with ropivacaine blockade (p=0.03).

CONCLUSION: The quality and severity of the blockade of the peripheral nerves of the brachial plexus when using articaine is not inferior to the blockade using ropivacaine. Articaine blockade differs from ropivacaine blockade by a higher rate of sensory anesthesia and a shorter duration of sensory and motor blocks. According to the frequency of complications in the articaine group, the occurrence of hoarseness of the voice was less frequent.