Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone

Abstract

Background and Aims:Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic.Methods:After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.Results:The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).Conclusion:Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.

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.…”

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

“…In the present study, the cesarean section rate was 24.24% in the levobupivacaine group, which validates the above point of view. Ropivacaine is less toxic to the heart than levobupivacaine, and it has a lighter neuromotor block effect (25). Combined spinal-epidural anesthesia with ropivacaine has a lesser influence on the cervical and vaginal motor nerves in the lower uterine segment, which decreases the birth canal resistance.…”

Comparison of the Safety and Effectiveness of Percutaneous Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation Under Epidural Anesthesia and General Anesthesia

“…Both EA and GA can prevent the pain but EA also can maintain the function of motor of lower limbs which is called sensory-motor separation. 17 Currently, the use of EA is comparatively infrequent. Ropivacaine has a stronger ability to inhibit nerve conduction in pain sensing fibers and low concentration medications can preserve motor function and only blocks sensation during surgery.…”