Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia

Kumar, Santosh; Palaria, Urmila; Sinha, Ajay; Punera, D C; Pandey, Vijita

doi:10.4103/0259-1162.134506

Cited by 40 publications

(18 citation statements)

References 35 publications

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“…Akin to our study, a comparative study conducted by Kumar et al ., using 0.5% ropivacaine with or without 8 mg dexamethasone, reported better (85%) surgeon satisfaction score in dexamethasone group as compared to control group (62.5%). [ 20 ] In our study, perioperative heart rate and blood pressure recordings in patients receiving dexmedetomidine for block were on lower side, but this was statistically insignificant. No patient developed significant bradycardia.…”

Section: Discussionmentioning

confidence: 50%

Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block

Singh

Gupta

Kathuria

2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Both dexmedetomidine and dexamethasone have individually been shown to be beneficial as an adjuvant to ropivacaine. We compared the efficacy of combination of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in ultrasound-guided supraclavicular brachial plexus (SCBP) block. Material and Methods: In this prospective randomised double-blind controlled trial, 60 ASA physical status I/II patients undergoing elective upper-limb surgery under ultrasound-guided SCBP block with 30 ml of 0.5% ropivacaine were randomised into three groups. Group 1 ( n = 20) received 1 μg/kg of dexmedetomidine, and group 2 ( n = 20) received 8 mg of dexamethasone in addition to ropivacaine, while group 3 ( n = 20) received only ropivacaine. The primary outcomes studied were onset and duration of sensory and motor block. Secondary outcomes included duration of analgesia, total analgesic consumption in 24 h postoperatively and quality of block. ANOVA and Chi-square test were used to compare results on continuous measurements and categorical measurements, respectively. Results: Onset of sensory and motor block was faster in group 1 (13.5 ± 4.1 and 17.0 ± 4.1 min) and group 2 (15.6 ± 3.6 and 18.5 ± 3.7 min) as compared to group 3 (20.1 ± 5.3 and 24.9 ± 5.6 min; P < 0.001). Block duration was significantly longer in group 1 and group 2 than in group 3. Duration of analgesia was prolonged in group 1 and 2 (1218.0 ± 224.6 and 1128.0 ± 207.5 min, respectively) as compared to group 3 (768.0 ± 273.7 min; P < 0.001). Twenty-four hours analgesic consumption postoperatively was reduced in the two study groups. Conclusion: Both dexmedetomidine and dexamethasone when used as adjuvants to ropivacaine for SCBP block, block onset time, and prolong' block duration.

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Section: Discussionmentioning

confidence: 50%

Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block

Singh

Gupta

Kathuria

2020

J Anaesthesiol Clin Pharmacol

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“…[ 15 ] In a study comparing dexamethasone at different doses as an adjuvant to bupivacaine for SCBP block, it was observed that 1 mg and 2 mg of dexamethasone prolonged the sensory and motor block duration to same extent as 4 mg.[ 16 ] Addition of dexamethasone (8 mg) to 30 mL of ropivacaine (0.5%) in brachial plexus block prolonged motor and sensory blockade as compared to ropivacaine alone, but it had no effect on the onset of sensory and motor block. [ 17 ] A meta-analysis concluded that dexamethasone produced late onset of sensory and motor block with prolongation of motor block duration and that the smaller doses of dexamethasone (4-5mg) were as equally effective as higher doses of dexamethasone (8-10mg). [ 18 ] However, the meta-analysis did not analyse any study using dexamethasone (8 mg) with levobupivacaine in supraclavicular brachial plexus block.…”

Section: Discussionmentioning

confidence: 99%

“…As far as time to first rescue analgesia was concerned, our study is in complete agreement with above studies. [ 15 16 17 18 ] but no agreement was found regarding the onset of block. In another study, the addition of 8 mg of dexamethasone to 30 mL of levobupivacaine reduced the onset of sensory and motor block and provided prolonged analgesia in supraclavicular brachial plexus block by paraesthesia technique.…”

Section: Discussionmentioning

confidence: 99%

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

et al. 2017

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Background and Aims:Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, the effect of dexamethasone (8 mg) when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in SCBP block.Methods:Ultrasound- guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi-square test and Student's t-test were used for statistical analysis.Results:Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S.Conclusion:The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.

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“…The exclusion criteria included pregnancy, diabetes mellitus, coagulopathy, local skin infection, surgeries with duration more than 180 min, and patients with allergy to local anesthetics or dexamethasone. The sample size was calculated based on a study by Kumar et al using ropivacaine and dexamethasone,[6] in which the mean duration of analgesia was 1179 ± 108.6 min. Considering this and to detect an effect size of 100 min with power of 80% and α error of 5%, the sample size calculated is 18.28 per group and we included 25 patients per group.…”

Section: Methodsmentioning

confidence: 99%

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

2019

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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.

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Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia

Cited by 40 publications

References 35 publications

Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block

Dexmedetomidine vs dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

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

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