A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Abstract

Background and objectivesThis multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours).MethodsThree hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block.ResultsNo intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9–16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours).Conclusions2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5–1 mg) doses of perineural dexamethasone for brachial plexus blocks.Trial registration numberTCTR20150624001.

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

“…21 Recent studies have shown that perineural high doses of dexamethasone have no advantage, and low doses of dexamethasone are advocated. 22 A recent meta-analysis showed very low quality evidence that there was a ceiling effect of dexamethasone at 4 mg. 23 However, the latest research findings that both intravenous and perineural administered dexamethasone 4 mg has no clinically relevant effect on the duration of sensory block provided by ropivacaine applied to the ulnar nerve in volunteers. 24 In addition, in the current study, we used a higher dose of dexamethasone than other experts have recommended.…”

Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block

“…The current trial was registered at www.clinicaltrials.gov (Study ID: NCT04875039) on 6 May 2021 prior to patient recruitment. The protocol used in the current study was similar to the one employed in our four previous trials investigating perineural dexamethasone or dexmedetomidine for brachial plexus blocks 1 3 13 14…”

“…A 6–13 MHz linear array ultrasound (US) transducer (General Electric LOGIC E, General Electric Healthcare, Wauwatosa, Wisconsin, USA) was applied in a sterile fashion in the infraclavicular fossa, medial to the coracoid process, to obtain a short axis view of the axillary artery 1 13 14. A skin weal was raised with 3 mL of lidocaine 1.0%.…”

Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review

“…Numerous reports have confirmed that dexamethasone and dexmedetomidine prolong the action time following the introduction of local anaesthesia to peripheral nerve block [4][5][6][7]. Combining dexamethasone or dexmedetomidine as a local anaesthetic adjuvant improves block characteristics, whether around the nerve or in the vein [8].…”