Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Abstract

Background: Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. Aim:To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Materials and Methods:Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Results:Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However, the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Conclusion:Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

Comparison of 4 mg dexamethasone versus 8 mg dexamethasone as an adjuvant to levobupivacaine in fascia iliaca block-a prospective study

“…In addition, we found that the duration of analgesia with 4 mg dexamethasone was 14.29 ± 2.45 h, which is statistically significant. In the same study by Suresh Kumar et al [ 17 ] consumption of Tramadol was found to be higher in patients receiving plain bupivacaine than patients with dexamethasone (8 mg), which was statistically significant. In our study, when two different doses of dexamethasone were compared, patients with a higher dose of dexamethasone (8 mg) had a lower consumption of tramadol then with those receiving a lower dose (4 mg), which implies that the effect of dexamethasone is dose-related in the FIB, as the duration of analgesia increased and the requirement of analgesics decreased with higher doses of dexamethasone, statistically.…”

“…Suresh Kumar et al [ 17 ] in their study on the FIB, have observed that when dexamethasone was added as an additive to plain bupivacaine, the duration of the block was prolonged to almost double (bupivacaine 7.85 ± 1.62 h; additional with 8 mg dexamethasone 16.33 ± 5.69 h; P < 0.05). The duration of the block with the addition of 8 mg dexamethasone in the study by Suresh Kumar et al [ 17 ] was found to be similar to what we got in our study with a similar dose (17.02 ± 0.45 h, P > 0.05). In addition, we found that the duration of analgesia with 4 mg dexamethasone was 14.29 ± 2.45 h, which is statistically significant.…”

“…Similarly, a meta-analysis for brachial plexus blocks by Knezevic and co-worker [ 19 ] found similar efficacy for 4 mg and 8 mg of dexamethasone. In the FIB, with a volume of 40 ml LA, Suresh Kumar et al [ 17 ], using 8 mg dexamethasone, showed a beneficial effect. However, in our comparative study of the FIB using 30 ml of LA solution, we found 8 mg dexamethasone to be advantageous over 4 mg.…”

A clinical comparative study of fascia iliaca compartment block with bupivacaine and bupivacaine with dexmedetomidine for positioning and duration of postoperative analgesia in fracture femur under spinal anesthesia

“…in their study on sixty patients with fracture femur administered FICB preoperatively where injection dexamethasone was used as an adjuvant to bupivacaine in one group of patients receiving FICB and the other group receiving injection bupivacaine with NS. [ 6 ] Duration of analgesia was noted using time to rescue analgesia which was administered when the VAS ≥4. In this study, the duration of analgesia was significantly longer in dexamethasone group which was 16.33 ± 5.69 h when compared to the other group which was 7.85 ± 1.62 h and was found statistically significant with P < 0.001.…”

“…and a pilot study, respectively. [ 6 ] Using these values at 99% confidence limit and 99% power, a sample size of 14 was obtained in each group. With 10% nonresponse, a sample size of 14 + 1.4 ≈ 16 cases was calculated in each group.…”