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

Ibrahim, Abdelrady S; Aly, Mahmoud; Farrag, Waleed Saleh; EL‐Rab, N.A. Gad; Said, Hatem G.; Saad, A.H.

doi:10.1002/ejp.1292

Cited by 24 publications

(23 citation statements)

References 33 publications

(42 reference statements)

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“…The results of this study confirm the efficacy of dexamethasone in prolonging the analgesic effect of bupivacain in the axillary block for upper limb surgery. Thus our investigation finds the result of several previous studies [5][6][7]. However, in these previous studies the results are variable ranging from 30 to 80% any route of administration confused, peri or intravenous.…”

Section: Discussionsupporting

confidence: 72%

Dexamethasone as an Adjuvant in the Axillary Echoguided Block: Prospective Single-Blind, Non-Randomized Study

Traoré¹

2019

JAICM

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Background : Dexamethasone has been used for some years as an adjunct to local anesthetics in peripheral nerve blocks. Recently studies suggest its effectiveness in prolonging the duration of postoperative analgesia. The primary objective of this study was to evaluate the efficacy of dexamethasone as adjuvant in the axillary ultrasound guided block.Methods: Adults who required upper limb surgery in a scheduled or emergency mode were prospectively divided into two groups of 30 patients. An axillary block under ultrasound guidance was performed with an equimolar mixture of lidocaine 2%-0.5% bupivacaine associated with dexamethasone in the dexamethasone group and without dexamethasone in the control group. The evaluation of the block was done by a blind operator of the block technique. All the parameters of the nerve block as well as the delay of the demand in analgesic were noted. The study was analyzed per protocol.Results: A total of sixty patients were grouped into two equitable groups. Demographic parameters were similar between two groups. The duration and the time of installation of the axillary block were respectively 13.76min (7-30) for the control group against 12.76min (5-20) for the dexamethasone group (p = 0.27) and 11.36min (5-30) for the control group 11.66 (5-30) for the dexamethasone group (p = 0.81). The duration of sensory block was extended in the dexamethasone group by about 56% compared to the control group. The motor block was also 21.5% longer in the dexamethasone group. The delay in the use of analgesics was significantly longer in the dexamethasone group with better EVS scores compared to the control group. Plexus neuropathy was found postoperatively. Conclusion:The use of dexamethasone as an adjuvant in the axillary block prolongs postoperative analgesia in a clinically significant manner and also leads to a decrease in analgesic consumption.

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Section: Discussionsupporting

confidence: 72%

Dexamethasone as an Adjuvant in the Axillary Echoguided Block: Prospective Single-Blind, Non-Randomized Study

Traoré¹

2019

JAICM

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“…Its perineural mechanism, although likely multifactorial, may stem from its anti-inflammatory actions [ 10 ]. Dexamethasone was proven to prolong the duration of an ACB when compared to control (bupivacaine only) and decrease opioid consumption [ 11 ]. Few studies have utilized the combination of Dex-Dex.…”

Section: Discussionmentioning

confidence: 99%

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Herman¹,

Urits²,

Eskander³

et al. 2020

Cureus

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Total knee arthroplasty (TKA) is among the most commonly performed orthopedic procedures. Controlling the pain of this patient population is essential in improving outcomes such as opioid consumption, hospital length of stay, overall function, and rehabilitation participation following their procedure. Local anesthetic infiltration of the interspace between the popliteal artery and capsule of the posterior knee, known as the IPACK block, combined with an adductor canal block (ACB) can be used to reduce pain in the challenging area of the posterior knee after knee surgery without compromising motor function of the quadriceps muscles. One limiting factor to this combination of techniques is the duration of analgesia provided. This case series demonstrates the combination of dexmedetomidine and dexamethasone (Dex-Dex) as local anesthetic adjuvants to significantly prolong the analgesic duration of ACB (in addition to IPACK block) in three patients undergoing TKA. Preoperative ACB and IPACK blocks were performed for postoperative analgesia in three TKA patients. The anesthetic mixture was 10 cc 0.2% ropivacaine combined with 25 mcg of dexmedetomidine and 5-mg preservative-free dexamethasone for the ACB, and 0.2% ropivacaine combined with 5-mg preservative-free dexamethasone was utilized for the IPACK block. Two of the patients reported experiencing four days of analgesia and one patient reported five days of analgesia following the ACB + IPACK block. Two of the patients required no opioid analgesics postoperatively. An ACB utilizing 0.75% ropivacaine has been demonstrated to provide approximately 10.8 hours of analgesia. Our series demonstrates a significantly prolonged duration of analgesia from this injectate combination. Few studies have utilized the Dex-Dex combination. The combination, however, was previously proven to safely increase the analgesic duration of a caudal block prior to hypospadias surgeries in pediatrics. More studies are needed to understand a potential synergistic effect of Dex-Dex, which could have a substantial impact on postoperative analgesia for TKA patients.

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“…We read with great interest the article by Ibrahim et al (2019) in a recent issue of the journal. The authors performed a randomized clinical trial in 60 patients undergoing arthroscopic anterior cruciate ligament reconstruction and concluded that the addition of dexamethasone to bupivacaine in adductor canal block provides prolonged post-operative analgesia and less post-operative analgesic consumption than bupivacaine alone.…”

Section: Comment On a Paper By Ibrahim Et Al Entitledmentioning

confidence: 99%

Comment on a paper by Ibrahim et al. entitled “Ultrasound‐guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial”

Mukhdomi

Kendall

2019

European Journal of Pain

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

Abstract: Adding dexamethasone to bupivacaine in adductor canal block significantly increases the duration of sensory block, time to first analgesic requirement and patients' satisfaction score in anterior cruciate ligament arthroscopic surgery.

Cited by 24 publications

References 33 publications

Dexamethasone as an Adjuvant in the Axillary Echoguided Block: Prospective Single-Blind, Non-Randomized Study

Dexamethasone as an Adjuvant in the Axillary Echoguided Block: Prospective Single-Blind, Non-Randomized Study

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Comment on a paper by Ibrahim et al. entitled “Ultrasound‐guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial”

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