Duration of Upper and Lower Extremity Peripheral Nerve Blockade Is Prolonged with Dexamethasone When Added to Ropivacaine: A Retrospective Database Analysis

Rasmussen, Stephanie B.; Saied, Nahel N.; Bowens, Clifford; Mercaldo, Nathaniel D.; Schildcrout, Jonathan S.; Malchow, Randall J.

doi:10.1111/pme.12150

Cited by 57 publications

(41 citation statements)

References 39 publications

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“…[21][22][23][24] The combination of ropivacaine and both particulate and non-particulate steroid agents, has been used for both various spinal and musculoskeletal diagnostic and therapeutic injections, with reports in the literature of such combinations being used for pain injections and infusions. [25][26][27][28][29][30] The combination of concern is that of ropivacaine and alkaline solutions, a category that dexamethasone sodium phosphate falls into with a pH of 8.0. This has been previously described in the literature when evaluating alkalising local anaesthetic agents, with reports of ropivacaine precipitating at a pH of 6.0 and above.…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

2015

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Introduction: Targeted spinal steroid injections are effective in reducing back pain in selected patient populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non-particulate steroid agents for all spinal injections to reduce the risk of neurovascular embolic adverse events. Many injections have used a combination of local anaesthetic agent with the steroid. At our institutions, we have recently observed interactions between ropivacaine and dexamethasone combinations ascribed to the incompatibility of the former with alkaline solutions, resulting in rapid crystallisation. This study has further investigated the combinations of commonly used local anaesthetic and steroid combinations to determine if such precipitation effects are more widespread. Methods: The commonly used local anaesthetics (lignocaine, bupivacaine, ropivacaine) and the non-particulate steroid dexamethasone sodium phosphate combinations were evaluated macroscopically, microscopically, and pH values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of ropivacaine with sodium bicarbonate solution was also evaluated. Particulate size of the particulate steroid agent betamethasone acetate was evaluated as a comparison. Results: All mixtures of ropivacaine and the non-particulate dexamethasone sodium phosphate assessed demonstrated a pH-dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of dexamethasone and lignocaine or bupivacaine. Contamination of ropivacaine with residual sodium bicarbonate in a drawing up needle following air clearing had a precipitation effect. Conclusion: We describe the effect of crystallisation with the combination of ropivacaine and the non-particulate steroid, dexamethasone sodium phosphate, a mixture that has been used in the literature for targeted pain injections. As this may be considered a non-particulate steroid/anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate steroid agents. This is due to the elevated pH of dexamethasone and the incompatibility of ropivacaine with alkaline solutions.

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Section: Discussionmentioning

confidence: 99%

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

2015

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“…The density of the block and analgesic duration increases as the ropivacaine concentration increases [15], which influenced our choice to utilize 1% ropivacaine. Dexamethasone has been proven to prolong the block duration [16], and epinephrine attenuates the early phase of local anesthetic absorption.…”

Section: Discussionmentioning

confidence: 99%

Bilateral thoracic paravertebral nerve blocks for placement of percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: a case series

Kalava

Clendenen

et al. 2016

Rom J Anaesth Int Care

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Background and Aims: To assess the efficacy of bilateral thoracic paravertebral nerve blocks (PVB) in providing procedural anesthesia and post-procedural analgesia for placement of percutaneous radiologic gastrostomy tubes (PRG) in patients with amyotrophic lateral sclerosis (ALS).Methods: We prospectively observed 10 patients with ALS scheduled for PRG placement that had bilateral thoracic PVBs at thoracic 7, 8, and 9 levels with administration of a mixture of 3 mL of 1% ropivacaine, 0.5 mg/mL dexamethasone, and 5 μg/mL epinephrine at each level. The success of the block was assessed after 10 minutes. PRG placement was done in the interventional radiology suite without sedation. All patients were followed up via phone 24 hours after the procedure.Results: All 10 patients had successful placement of PRG with PVBs as the primary anesthetic. Segmental anesthesia over the surgical site in all cases was successful with first attempt of the blocks. Three patients had significant hypotension after the block, requiring boluses of vasopressors and intravenous fluids. All patients reported high levels of satisfaction and sleep quality on the night of the procedure.Conclusions: Bilateral thoracic PVBs provided satisfactory procedural anesthesia and post-procedural analgesia, and thus, seem promising as a safe alternative to sedation in ALS patients having PRG placement.

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“…24 Rasmussen ve ark.nın yaptıkları retrospektif gözlemde, üst ve alt ekstremite periferik bloklarında %0,5 ropivakaine eklenen deksametazonun blok süresini uzattığını belirtilmiştir. 25 Bupivakain-fentanil solusyonu ve deksametazonun epidural analjezi için birlikte kullanıldığı bir çalışmada da, deksametazonun abdominal ve torasik cerrahilerde uygulanan analjezi süresini uzattığı gösterilmiştir. 26 …”

Section: Discussionunclassified

Effects of Dexamethasone Added to Levobupivacaine During USG-Guided Infraclavicular Brachial Plexus Block

Kilinc¹,

Özbek²,

Guzeldag³

et al. 2014

Turkiye Klinikleri J Med Sci

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Duration of Upper and Lower Extremity Peripheral Nerve Blockade Is Prolonged with Dexamethasone When Added to Ropivacaine: A Retrospective Database Analysis

Abstract: The addition of dexamethasone to 0.5% ropivacaine prolongs the duration of peripheral nerve blocks of both the upper and lower extremity.

Cited by 57 publications

References 39 publications

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

Bilateral thoracic paravertebral nerve blocks for placement of percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: a case series

Effects of Dexamethasone Added to Levobupivacaine During USG-Guided Infraclavicular Brachial Plexus Block

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