Efficacy of articaine for brachial plexus block: a prospective randomized study

BACKGROUND: Articaine is widely used for infiltration and conduction anesthesia in dentistry; however, few studies have examined its use in regional blocks during limb surgeries.

AIM: The work aimed to compare the effectiveness of regional anesthesia with articaine versus ropivacaine in upper limb surgeries.

METHODS: A single-center, prospective, randomized study was conducted. It included 60 patients (all male), aged 35.2 ± 15.3 years, who underwent upper limb surgery under regional anesthesia. Patients were randomized into two groups: group 1 (n = 30) received 2% articaine, and group 2 (n = 30) received 0.5% ropivacaine. The groups were divided into subgroups (n = 15) based on the approach used: interscalene or axillary. The primary endpoint was the onset of sensory and motor block. Secondary endpoints included block duration and the incidence of adverse effects (nausea/vomiting, arterial hypotension, bradycardia, and dizziness).

RESULTS: When evaluating sensory block characteristics 30 minutes after anesthetic administration, statistically significant differences were observed only in the rate of block onset. In the articaine group, sensory block developed more rapidly with both the interscalene (group 1: 7.0 ± 2.9 min vs group 2: 10.0 ± 3.1 min [p = 0.015]) and axillary approaches (group 1: 8.0 ± 2.1 min vs group 2: 12.0 ± 4.2 min [p = 0.02]). Interscalene block resulted in complete shoulder immobility in 12 (80%) patients in group 1 and 13 (86.7%) in group 2. With axillary block, finger flexion was absent in 8 (53.3%) patients in group 1 and 9 (60%) in group 2 (p = 0.117). The block duration was longer in group 2 than in group 1, both for the interscalene approach (sensory: 12.1 ± 5.4 h vs 3.1 ± 0.5 h [p = 0.001]; motor: 5.3 ± 2.2 h vs 2.2 ± 0.8 h [p = 0.016]) and the axillary approach (sensory: 10.3 ± 3.2 h vs 2.8 ± 0.7 h [p = 0.001]; motor: 4.9 ± 1.4 h vs 1.7 ± 0.4 h [p = 0.02]). For complication rates, hoarseness was more frequently observed in the ropivacaine group (p = 0.03).

CONCLUSION: The quality and intensity of brachial plexus block using articaine is comparable to that of ropivacaine. Articaine block was characterized by a faster onset of sensory anesthesia and a shorter duration of both sensory and motor block compared with ropivacaine. For complication rates, hoarseness occurred less frequently in the articaine group.