A Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block

Abstract

Compared with its IV counterpart, PN dexamethasone (5 mg) provides a longer duration of motor block, sensory block, and postoperative analgesia for US-guided infraclavicular block. Future dose-finding studies are required to elucidate the optimal dose of dexamethasone.

A randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided axillary block

“…In a recent multicentre trial comparing intravenous (IV) and perineural (PN) administration of dexamethasone for ultrasound (US)-guided infraclavicular block (n = 150), we showed that the PN modality provided longer sensorimotor block and analgesia. 20 Nevertheless, other trials have failed to detect significant differences between IV and PN dexamethasone. 5,16,21,22 We speculated that these contradictory findings in the literature may stem from differences in the doses of dexamethasone and local anesthetic (LA) used as well as insufficient statistical power due to small sample sizes.…”

“…Sensory block of the musculocutaneous, median, radial, and ulnar nerves was graded according to a three-point scale using a cold test: 0 = no block; 1 = analgesia (patient can feel touch but not cold sensation); 2 = anesthesia (patient cannot feel touch). 20,[24][25][26] The musculocutaneous, median, radial, and ulnar nerves were assessed on the lateral aspect of the forearm, the volar aspect of the thumb, the lateral aspect of the dorsum of the hand, and the volar aspect of the fifth finger, respectively. 20,[24][25][26] Motor block was also graded on a threepoint scale: 0 = no block; 1 = paresis; 2 = paralysis.…”

“…20,[24][25][26] The musculocutaneous, median, radial, and ulnar nerves were assessed on the lateral aspect of the forearm, the volar aspect of the thumb, the lateral aspect of the dorsum of the hand, and the volar aspect of the fifth finger, respectively. 20,[24][25][26] Motor block was also graded on a threepoint scale: 0 = no block; 1 = paresis; 2 = paralysis. 20,[24][25][26] The musculocutaneous, radial, median, and ulnar nerves were evaluated by elbow flexion, thumb abduction, thumb opposition, and thumb adduction, respectively.…”

“…In addition, different nerve blocks may respond differently to IV and PN dexamethasone. 20 Accordingly, we designed the current trial as a followup to our previous study which demonstrated prolonged sensorimotor blockade with PN dexamethasone for infraclavicular block. 20 In order to validate our previous findings, we sought again to compare IV and PN dexamethasone, by using a different (i.e., axillary) approach to the brachial plexus.…”

“…20 Accordingly, we designed the current trial as a followup to our previous study which demonstrated prolonged sensorimotor blockade with PN dexamethasone for infraclavicular block. 20 In order to validate our previous findings, we sought again to compare IV and PN dexamethasone, by using a different (i.e., axillary) approach to the brachial plexus. We selected motor block duration as the primary outcome because the latter is arguably more objective than sensory blockade since analgesic and sensory duration can be influenced by concomitant pain medications and surgical trauma to small cutaneous nerves, respectively.…”