Comparison of dexamethasone and buprenorphine as adjuvant in ultrasound-guided brachial plexus blocks: A randomized controlled trial

Abstract

Introduction:Effective postoperative analgesia is imperative for orthopedic surgeries to enhance recovery and facilitate early ambulation. Various additives have been used as adjuvants with local anesthetics in peripheral nerve blocks to provide postoperative analgesia. The aim of this study is to compare the duration of postoperative analgesia with buprenorphine and dexamethasone when administered as an adjuvant during ultrasound-guided brachial plexus blocks.Methodology:Sixty adult patients undergoing various upper arm surgeries were recruited for the study after acquiring ethics committee clearance. They were randomized into two groups of thirty; Group B was given ultrasound-guided supraclavicular block with 10 ml 2% lignocaine with adrenaline and 15 ml 0.5% bupivacaine and 4 mg dexamethasone as adjuvant. Group B was given the same amount of local anesthetics with 0.3 mg buprenorphine as the adjuvant. The duration of postoperative analgesia and incidence of adverse events if any were noted.Results:Both groups were comparable in demographics, time for onset of sensory, and motor block. The duration of postoperative analgesia was 17.4 ± 3.4 h in the buprenorphine group and 18 ± 3.49 h in the dexamethasone group. None of the patients had significant adverse effects. A single dose of buprenorphine and dexamethasone administered perineurally can provide significant postoperative analgesia for upper limb surgeries.

Effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial

“…The study subjects were American Society of Anaesthesiologists (ASA) I-II patients presenting for elective TMS under inferior alveolar block local anaesthesia. The sample size calculation was performed using the formula 2 SD 2 (Za/2+Zβ) 2 /d 2 , where SD (standard deviation from the previous study), Za/2 (standard normal variance to the level of significance [1% type I error, P <0.01 was 2.58]), (Zβ=standard normal variance for power [for 90% power was 1.28]), d (effect size [the difference between the mean value of the previous study]) 27 - 34 . The participants were randomly assigned into two groups: 1st, dexamethasone group (DXN) and 2nd, adrenaline group (ADN).…”

“…The most commonly used adjuvant drugs are dexamethasone 18 , 24 - 30 , α 2 agonists (i.e., clonidine and dexmedetomidine) 19 , 20 , opioids (i.e., buprenorphine) 29 , ketamine 24 , midazolam 25 , hyaluronidase 26 , and neostigmine 27 . Dexamethasone has been frequently used as an adjuvant for various nerve blocks, i.e., brachial plexus, femoral, intercostal, and axillary nerve blocks, during limb surgery 27 - 33 , but the exact mechanism of prolonged nerve blocks remains unclear. However, the adjuvant use of dexamethasone was not studied with IANB.…”

A comparative study of dexamethasone versus midazolam as adjuvant to 0.5% bupivacaine in ultrasound-guided supraclavicular brachial plexus block for upper-limb surgeries

“…Adjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. [ 2 ]…”