Comparison between Intravenous and Perineural Dexamethasone in Prolonging the Analgesic Effect of Supraclavicular Plexus Nerve Block

Abstract

Background poor controlled acute pain post-surgery is accompanied with several unwanted postoperative consequences, including patient agony, distress, myocardial ischemia, increased hospital stays and an increased possibility of post-operative chronic pain. Aim of the Work to study the effect of dexamethasone as a supplementary to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the motor and sensory blocks, the duration of analgesia of the block and their effect on the postoperative analgesic needs. The effect of the drugs on hemodynamics and monitoring for the occurrence of any complication. Patients and Methods in our study, 50 patients were randomly divided into 2 equal groups. Perineural group received bupivacaine (0.5%) assosciated with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone was injected systemically. All patients received equal volumes of 20 milliliters. Results our study revealed that adding 8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block decreased the onset times of motor and sensory blocks and significantly increased their durations. In addition, dexamethasone prolonged the time of analgesia of the plexus block markedly, as shown by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic needs were much lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone. Conclusion addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than injecting dexamethasone intravenously. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously.