Effect of dexamethasone in low volume supraclavicular brachial plexus block: A double-blinded randomized clinical study

Abstract

Background and Aims:With the use of ultrasound, a minimal effective volume of 20 ml has been described for supraclavicular brachial plexus block. However achieving a long duration of analgesia with this minimal volume remains a challenge. We aimed to determine the effect of dexamethasone on onset and duration of analgesia in low volume supraclavicular brachial plexus block.Material and Methods:Sixty patients were randomly divided into two groups of 30 each. Group C received saline (2 ml) + 20 ml of 0.5% bupivacaine and Group D received dexamethasone (8 mg) + 20 ml of 0.5% bupivacaine in supraclavicular brachial plexus block. Hemodynamic variables and visual analog scale (VAS) score were noted at regular intervals until 450 min. The onset and duration of sensory and motor block were measured. The incidence of “Halo” around brachial plexus was observed. Student's t-test and Chi-square test were used for statistical analysis.Results:The onset of sensory and motor block was significantly earlier in dexamethasone group (10.36 ± 1.99 and 12 ± 1.64) minutes compared to control group (12.9 ± 2.23 and 18.03 ± 2.41) minutes. The duration of sensory and motor block was significantly prolonged in dexamethasone group (366 ± 28.11 and 337.33 ± 28.75) minutes compared to control group (242.66 ± 26.38 and 213 ± 26.80) minutes. The VAS score was significantly lower in dexamethasone group after 210 min. “Halo” was present around the brachial plexus in all patients in both the groups.Conclusion:Dexamethasone addition significantly increases the duration of analgesia in patients receiving low volume supraclavicular brachial plexus block. No significant side-effects were seen in patients receiving dexamethasone as an adjunct.

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

“…Further, Alarasan et al. () also found no statistically significant differences in the onset of sensory and motor block when dexamethasone was used as an adjuvant to bupivacaine in supraclavicular brachial plexus block.…”

Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

“…The addition of dexamethasone to regional anesthetics such as lidocaine, bupivacaine, and other sodium channelblocking anesthetics has been shown to prolong the duration of analgesia. 5,11,[32][33][34][35][36][37] Recently, a meta-analysis of nine randomized trials by Choi et al 1 found that the addition of dexamethasone to regional anesthetics prolongs the duration of analgesia by approximately six hours. Furthermore, they reported a trend towards decreased opioid consumption.…”

Effect of dexamethasone on characteristics of supraclavicular nerve block with bupivacaine and ropivacaine: A prospective, double-blind, randomized control trial

“…Increasing duration of local anesthetic action is desired for prolongation of postoperative patient comfort, as well as decreasing perioperative opioid consumption and subsequent side effects. Many adjuvants to local anesthetics such as epinephrine, clonidine,[ 1 ] tramadol, opioids,[ 2 ] dexmedetomidine, and neostigmine have been studied in brachial plexus block, but each drug has its own side effects,[ 3 ] and analgesic effect extends only up to early postoperative period. Recently, dexamethasone,[ 4 ] a glucocorticoid, when used as an adjuvant to local anesthetics in brachial plexus block has been found to have prolonged postoperative analgesia and a favorable side effect profile.…”