Comparison of the use of levobupivacaine with dexamethasone versus plain levobupivacaine in patients undergoing forearm surgeries under an infraclavicular block - a double-blinded randomized controlled trial

Abstract

Regional anesthesia can provide greater patient satisfaction. An infraclavicular approach to block the brachial plexus aided with ultrasound is proven to be safe. Lesser toxic, levobupivacaine, advocates its use, with the addition of dexamethasone, to prolong the action. After approval from the ethics committee, the consenting patients, for orthopedic forearm surgeries, were recruited, randomized into two groups of 20 patients. Group-A, received 30mls of 0.5% levobupivacaine with dexamethasone 4mgs(1ml) and Group-B,30mls of 0.5% levobupivacaine and 1ml normal saline.18-70 Year olds, ASA I-III, weight greater than or equal to 50 kg, were included and non-consenting, coagulopathic, local infection, pregnant women, general anesthesia requirement, less than 50kg, allergy to local anesthetic, were excluded. Both groups received the infraclavicular block. The onset and duration of sensory and motor blockade were noted. Comparisons made at 3 and 20 minutes. Required data was acquired. Visual Analogue Scale(VAS)used to assess pain. The onset of sensory and motor blockade was assessed and graded separately on radial, median and ulnar nerves, with significant findings of about 70-80% in Group-A at 4-5 minutes,80-87% complete at 20 minutes.87.5% Patients in both groups achieved adequate surgical anesthesia. There was a significant improvement in sensory grading of the median nerve and ulnar nerve between at 3 minutes and 20 minutes and also in motor grading improvement at 20 minutes duration in the Group-A than Group-B. Postoperatively, the VAS score showed scores hovering around 1-4, over 24 hours, with no difference, in scores, duration, and use of rescue analgesia in both arms. There were no statistical differences in the onset and duration of sensory and motor blockade in both groups, with some difference in the quality of analgesia between the nerves studied in group-A. Although a larger sample size might have brought out some difference in pain scores, with the addition of dexamethasone, its clinical implication is doubtful.