Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial

Holland, Darren; Amadeo, Ryan J. J.; Wolfe, Scott W.; Girling, Linda G.; Funk, Faylene; Collister, Mark; Czaplinski, Emily; Ferguson, Celeste; Leiter, Jeff; Old, Jason; MacDonald, Peter; Dufault, Brenden; Mutter, Thomas C

doi:10.1007/s12630-017-0989-7

Cited by 47 publications

(49 citation statements)

References 30 publications

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“…For interscalene blocks, studies by Tandoc et al ,2 Woo et al ,26 and Holland et al 27 have found no intergroup differences in terms of block duration or time to first analgesia. In contrast, for supraclavicular blocks, Patel et al 28 detected longer motor blockade and postoperative analgesia with 8 mg compared with 4 mg of PN dexamethasone.…”

Section: Discussionmentioning

confidence: 94%

“…In light of the conflicting results stemming from previous studies by Tandoc et al ,2 Woo et al ,26 Holland et al ,27 and Patel et al ,28 a practical argument could be made to systematically administer 8 mg of PN dexamethasone for brachial plexus blocks, thereby increasing the odds of maximizing postoperative analgesia. However, despite its increasing popularity,1–21 PN remains an off-label adjuvant.…”

Section: Discussionmentioning

confidence: 99%

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A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Bravo

Layera

Fernández

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThis multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours).MethodsThree hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block.ResultsNo intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9–16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours).Conclusions2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5–1 mg) doses of perineural dexamethasone for brachial plexus blocks.Trial registration numberTCTR20150624001.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Bravo

Layera

Fernández

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

View full text Add to dashboard Cite

show abstract

“…Albrecht et al (2015), in their meta-analysis, concluded that perineural dexamethasone was associated with longer duration of analgesia and can reduce postoperative morphine consumption and pain scores (Albrecht et al, 2015). Holland and his colleagues also found that perineural dexamethasone increases the duration of interscalene block despite the dose and the administration route (Holland et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial

Ibrahim

Aly

Farrag

et al. 2018

European Journal of Pain

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“…Limited comparative efficacy among routes of administration has emerged. This appears most true for dexamethasone, which confers similar benefits to pain control and opioid use when administered via either modality [259,[327][328][329][330]333]. Although administering dexamethasone as a component of peripheral nerve blockade may avoid systemic side effects, perineural dexamethasone may have a local effect on nerve tissues that may be undesirable in some patient populations.…”

Section: Systemic Multimodal Adjunctsmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial

Abstract: www.clinicaltrials.gov (NCT02426736). Registered 14 April 2015.

Cited by 47 publications

References 30 publications

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Ultrasound‐guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

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