Effect of perineural and intravenous dexamethasone on duration of analgesia in supraclavicular brachial plexus block with bupivacaine: A comparative study

Abstract

Background: Perineural dexamethasone has been shown to improve analgesia in single injection supraclavicular block. Systemic mechanism of action of dexamethasone along with safety concerns of perineural route of administration has prompted the investigation of intravenous route as an alternative. Aims: We aim to compare the effects of dexamethasone as an additive to local anesthetic when used via perineural and intravenous route in terms of duration of analgesia and onset of motor and sensory block. Settings and Design: The study was done as a prospective comparative observational study conducted in a tertiary care hospital in India among 50 patients during a period of 1 year. Materials and Methods: Twenty-five patients aged 18–60 years, belonging to the American Society of Anesthesiologists physical status Classes I and II, receiving supraclavicular block with 0.5% bupivacaine and perineural dexamethasone were compared with similar number of patients receiving the block along with intravenous dexamethasone. Duration of analgesia, onset of sensory block, and onset of motor block were studied. Statistical Analysis: The results were analyzed using Chi-square test for qualitative variables and unpaired t -test for quantitative variables. Results: The duration of analgesia in the group receiving perineural dexamethasone (Group DP) 817.2 ± 88.011 min was comparable to the group receiving intravenous dexamethasone (Group DI) 858.00 ± 86.168, with a P = 0.104. Time to onset of sensory block in Group DP (10.20 ± 1.443 min) was significantly faster than that of Group DI (11.60 ± 1.443) with a P = 0.001. Time to onset of motor block in Group DP (13.92 ± 1.754 min) was significantly earlier than that of Group DI (14.96 ± 1.274 min) with a P = 0.02. Conclusion: It is concluded from this study that intravenous and perineural dexamethasone equally prolongs the duration of analgesia in supraclavicular block. However, perineural dexamethasone resulted in a faster onset of motor and sensory blockade.

RETRACTED: The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study

“…First analgesic request time: the initial time patients need pain intervention postoperatively. 25,26 Total analgesic consumption: postoperative analgesic drugs given to the patient in 24 h.…”

Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks

“…The static and dynamic NRS in both groups P and S were significantly less (P < 0.05) at 12 and 24 h compared to group C. The duration of the SPB below the serratus anterior muscle as proposed by Blanco et al was approximately 360 min. The longer duration seen in our study can be explained by the use of dexamethasone, which was given to relieve PONV [18,19].…”

“…Although, Fajardo et al [12], in his study on SIFP, reported controlled hemodynamic parameters on the surgical incision that did not require rescue opioid dose despite less time between the block and surgery. In the literature, dexamethasone has been shown to delay the onset of block action [18]. Therefore, if we had waited longer before the surgical incision, we potentially could have controlled the hemodynamic parameters in group S (SIFP) as well.…”

Evaluation of Addition of Sodium Bicarbonate to Dexamethasone and Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Orthopedic Procedures

“…The prolongation of the effect of local anesthetic by the addition of dexamethasone, as seen in Group D in our study, has also been seen by multiple workers. Mathew et al [ 9 ] compared intravenous dexamethasone and perineural dexamethasone in supraclavicular block and found that the perineural dexamethasone group had a faster onset of sensory and motor blocks. Pathak et al [ 10 ] noticed significant prolongation of sensory and motor block when dexamethasone was added to a mixture of 1.5% adrenalized xylocaine and 0.5% bupivacaine.…”