Jiabin Liu1, Kenneth A Richman2, Samuel R Grodofsky2, Siya Bhatt2, George Russell Huffman3, John D Kelly3, David L Glaser3, Nabil Elkassabany2. 1. Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104. Electronic address: Jiabin.liu@uphs.upenn.edu. 2. Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104. 3. Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
Abstract
STUDY OBJECTIVE: The study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block. DESIGN: The design is a prospective randomized double-blinded clinical study. SETTING: The setting is an academic medical center. PATIENTS: The patients are 89 adult patients scheduled for shoulder arthroscopy. INTERVENTIONS: All patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia. MEASUREMENTS: The measurements are the duration of analgesia and motor block. MAIN RESULTS: The median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively (P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend (P = .0247). CONCLUSION: Low-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block.
RCT Entities:
STUDY OBJECTIVE: The study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block. DESIGN: The design is a prospective randomized double-blinded clinical study. SETTING: The setting is an academic medical center. PATIENTS: The patients are 89 adult patients scheduled for shoulder arthroscopy. INTERVENTIONS: All patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia. MEASUREMENTS: The measurements are the duration of analgesia and motor block. MAIN RESULTS: The median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively (P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend (P = .0247). CONCLUSION: Low-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block.
Authors: Jacques T YaDeau; Michael A Gordon; Enrique A Goytizolo; Yi Lin; Kara G Fields; Amanda K Goon; Guilherme Holck; Timothy W Miu; Lawrence V Gulotta; David M Dines; Edward V Craig Journal: Pain Med Date: 2015-12-14 Impact factor: 3.750
Authors: Mary F Chisholm; Jennifer Cheng; Kara G Fields; Robert G Marx; Daniel B Maalouf; Gregory A Liguori; Michael A Gordon; Victor M Zayas; Jacques T Yadeau Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-04-13 Impact factor: 4.342