scholarly journals The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial

2021 ◽  
Vol 11 (12) ◽  
pp. 1267
Author(s):  
Boohwi Hong ◽  
Chahyun Oh ◽  
Yumin Jo ◽  
Woosuk Chung ◽  
Eunhye Park ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Block ◽  
Mixed Effect ◽  
Saline Bolus ◽  
Significant Prolongation ◽  
Midazolam Infusion ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Dexmedetomidine Infusion

Intravenous dexamethasone and dexmedetomidine, in conjunction with peripheral nerve blockade, have each been reported to prolong the duration of analgesia. This study tested whether combined use further prolongs analgesia duration after supraclavicular brachial plexus block (BPB) in patients undergoing orthopedic upper extremity surgery. One hundred twenty patients were randomized 1:1:1:1 to Control (saline bolus and midazolam infusion [0.05 mg/kg loading, 20 µg/kg/h thereafter]); DMED (saline bolus and dexmedetomidine infusion [1 μg/kg loading, 0.4 μg/kg/h thereafter]); DEXA (dexamethasone [10 mg] bolus and midazolam infusion); and DMED-DEXA (dexmedetomidine infusion and dexamethasone bolus) groups. The primary outcome was the duration of postoperative analgesia, defined as the time from the end of the BPB to the first dose of analgesia via a patient-controlled device. Median (interquartile range) times to first dose of analgesia in the Control, DMED, DEXA, and DMED-DEXA groups were 8.1 (6.2–11.6), 9.0 (8.1–11.3), 10.7 (8.1–20.5), and 13.2 (11.5–19.1) hours, respectively (p < 0.001). Pairwise comparisons showed significant prolongation of analgesia in the DEXA included groups compared with the non-DEXA included groups (DEXA vs. control, p = 0.045; DEXA vs. DMED, p = 0.045; DMED-DEXA vs. control, p < 0.001; DMED-DEXA vs. DMED, p < 0.001). A mixed effect model showed that dexamethasone was the only significant factor for the prolongation of analgesia (p < 0.001). Intravenous dexamethasone prolonged the analgesia duration of supraclavicular BPB after orthopedic upper extremity surgery. The concurrent use of mild to moderate sedation dose of intravenous dexmedetomidine in addition to intravenous dexamethasone showed no additional benefit to the prolongation of analgesia.

scholarly journals Dexamethasone added to Bupivacaine prolongs the duration of analgesia for supraclavicular brachial plexus block

2018 ◽  
Vol 17 (2) ◽  
pp. 296-301
Author(s):  
Naimul Hoq ◽  
Abdullah Al Maruf
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Block ◽  
Medical Science ◽  
Local Anaesthetics ◽  
Distilled Water ◽  
Dexamethasone Group ◽  
Prolonged Duration ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia. Numerous adjuncts have been added to enhance the efficacy of the block. Steroids have anti-inflammatory as well as analgesic effects.Objectives: This study has been undertaken with a view to find out the efficacy of dexamethasone to increase the duration of analgesia when used as an adjuvant to bupivacaine in supraclavicular brachial plexus block in upper extremity surgery.Methods: Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block were randomly divided into two equal groups of 30 each; Bupivacaine group-‘’A’’ received 0.5% bupivacaine 2 mg/kg with distilled water 15 ml and Dexamethasone group-‘’B’’ received 0.5% bupivacaine 2 mg/kg with dexamethasone (0.2mg/kg) with distilled water 15 ml. The duration of analgesia in the two groups were compared.Results: There was markedly prolonged duration of analgesia in dexamethasone group. The mean duration of analgesia in bupivacaine group was 455 ± 17.09 minutes, whereas in dexamethasone group it was 864.50 ± 25.19 minutes. The results were statistically highly significant.Conclusion: Dexamethasone when added to bupivacaine in brachial plexus block it results significantly prolonged duration of post-operative analgesia, which was significantly higher in comparison to bupivacaine when it is used alone.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.296-301

scholarly journals Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries

2017 ◽  
Vol 5 (5) ◽  
pp. 1943 ◽  
Author(s):  
Kartheek Hanumansetty ◽  
Hemalatha S. ◽  
Gurudatt C. L.
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Upper Limb ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Peak Effect ◽  
Motor Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: The supraclavicular brachial plexus block has proven to be an important, safer and effective alternative to general anaesthesia in surgeries of upper extremity. Primary aim is to study the effect of addition of dexamethasone to levobupivacaine on postoperative analgesia and secondary objectives are to study onset, peak effect and duration of sensory and motor block in brachial plexus blockade in adult patients posted for upper limb surgeriesMethods: This prospective randomized clinical study was conducted on 60 patients of age 18 to 60 years posted for upper limb surgeries. They were randomly allocated into two groups of 30. In Control group LS (n=30) received Inj. Levobupivacaine 30ml and Inj. Normal saline 2ml. In Study group LD (n=30) received Inj. Levobupivacaine 30ml and Inj. Dexamethasone 2ml (8mg).Results: Both the groups were demographically comparable. Onset of sensory block and motor block in group LD and in group LS were similar (p>0.05). Mean duration of sensory and motor block in group LD was higher than in group LS (<0.001). Duration of postoperative analgesia was 21.20±3.23 hours in group LD and 10.24±1.57 hours in group LS (p<0.001).Conclusions: Dexamethasone added to levobupivacaine for brachial plexus block prolonged the duration of sensory, motor blockade and postoperative analgesia but did not alter the onset time, peak effect time of sensory and motor blockade.

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