Brachial plexus anesthesia with verapamil and/or morphine

Calcium channel blockers potentiate the analgesic properties of both local anesthetics and opioids. We examined the analgesic effects of administering morphine, verapamil, or its combination into the brachial plexus sheath wi th lidocaine in 75 patients undergoing upper extremity orthopedic surgery. All patients received brachial plexus anesthesia with 40 mt of 1.5% lidocai ne and epinephrine 5 mu g/mL. In addition, patients were randomized to 1 of 5 groups: Group 1 received IV saline; Group 2 received IV verapamil 2.5 mg and morphine 5 mg; Group 3 received IV verapamil 2.5 mg and morphine 5 mg was added to the lidocaine solution; Group 4 received TV morphine 5 mg and verapamil 2.5 mg was added to the lidocaine solution; and Group 5 received verapamil 2.5 mg and morphine 5 mg were added to the lidocaine solution. Po stoperatively, patients rated their pain (0-10) at 1, 6, 12, and 24 h. Pati ents were instructed to take 1 acetaminophen 325 mg/ oxycodone 5 mg tablet every 3 h whenever the pain score exceeded 3. Analgesic duration was signif icantly increased in those patients receiving brachial plexus blocks with m orphine (Groups 3 and 5) (P < 0.005). The total 24 h acetaminophen/oxycodon e use was also less in Groups 3 and 5 (P < 0.03). Duration of anesthesia (t ime of abolition of pinprick response) was significantly increased in those patients receiving brachial plexus blocks with verapamil (Groups 4 and 5) (P = 0.002). We conclude that the addition of verapamil to brachial plexus block with lidocaine can prolong the duration of sensory anesthesia, but it had no effect on analgesic duration of 24 h analgesic use.