Dexamathasone added to levobupivacaine improves postoperative analgesia in ultrasound guided interscalene brachial plexus blockade for arthroscopic shoulder surgery

Abstract

BackgroundThe purpose of this study was to evaluate the effect of the addition of 5 mg dexamethasone to 10 ml of 0.5% levobupivacaine on postoperative analgesic effects of ultrasound guided-interscalene brachial plexus block (ISBPB) in arthroscopic shoulder surgery under general anesthesia.MethodsIn 60 patients scheduled for arthroscopic shoulder surgery that underwent general anesthesia, ISBPB was preoperatively performed with 10 ml of 0.5% levobupivacaine under the guidance of ultrasound and a nerve stimulator. Patients were randomly allocated to receive the same volume of normal saline (Group I), 5 mg of dexamethasone (Group II), or 1 : 400,000 epinephrine (Group III) as an adjuvant to the mixture. A blind observer recorded total analgesic consumption, sleep quality, complication, and patient satisfaction using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, 48 h after the operation.ResultsAll patients had successful ISBPB and excellent analgesic effects less than VNRS 4 up to discharge time. VNRS in Group II at 12 h and 48 h was statistically much lower than in Group I and III. There were no differences in total analgesic consumption, sleep quality, complications, and patient satisfaction.ConclusionsWe conclude that the addition of 5 mg of dexamethasone to 10 ml of 0.5% levobupivacaine in ISBPB showed improvement of postoperative analgesia for arthroscopic shoulder operation without any specific complications.

A systematic review and meta‐analysis of perineural dexamethasone for peripheral nerve blocks

“…All but six studies [20, 35-37, 39, 47] examined brachial plexus blockade: interscalene [16,17,21,45,46,53]; supraclavicular [19, 28, 38, 40-44, 48-50, 52, 54, 55] or axillary [18,51,56]. The injection was placed under ultrasound guidance [17, 19-21, 36, 37, 45, 46, 48, 50, 54], with a nerve stimulator [16,18,40,42,49,[51][52][53]55] or following anatomical landmarks [28,35,38,39,41,43,44,47,56], and was supplemented by general anaesthesia in seven RCTs [16,17,21,37,45,46,53] or spinal anaesthesia in one RCT [36]. The administered dose of dexamethasone was 4 mg [28,35,39 [16].…”

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

“…Recientes estudios sugieren [22][23][24][25][26][27][28][29][30]91 que la dexametasona usada junto con los anestésicos locales para realizar bloqueos del plexo braquial, aumenta el tiempo de analgesia en cirugía de artroscopia de hombro y de miembro superior sin repercusiones hemodinámicas ni efectos secundarios negativos para el paciente.…”

“…Este resultado concuerda con los principales estudios revisados [22][23][24][25][26][27][28][29][30] , en los que se aprecia que la dexametasona prolonga en mayor o menor medida el tiempo de analgesia del bloqueo locorregional realizado. Una comparación directa con los distintos estudios resulta compleja pues la mayoría se basan en cirugías del miembro superior (cirugía artroscópica de hombro, cirugía ambulatoria de la mano y antebrazo, cirugía del codo) en las que se han realizado bloqueos del plexo braquial (interescalénico, supraclavicular, axilar) con distintas combinaciones de anestésicos locales (bupivacaína, ropivacaína, levobupivacaína, mepivacaína, lidocaína, prilocaína) y dexametasona (4-10 mg).…”

“…Los agonistas de los receptores alfa-2 adrenérgicos (clonidina 20 y dexmetomidina 21 ) sí han demostrado prolongar de forma significativa la analgesia pero con importantes efectos adversos. Sin embargo, la dexametasona prolonga el efecto analgésico en bloqueos nerviosos del plexo braquial [22][23][24][25][26][27][28][29][30] y del nervio ciático 31,32 sin efectos secundarios. Esta propiedad parece ser debida a que por un lado, la dexametasona atenúa los mediadores de la respuesta inflamatoria producida por la cirugía, al disminuir la descarga neuronal ectópica e inhibir los canales de potasio dependientes de las fibras C-Nociceptivas [33][34][35][36] , y por otro lado a su poder de vasoconstricción 31 , disminuyendo por tanto la absorción de los AL.…”

Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade

“…The analgesic effects of spinal and systemic corticosteroids in combination with local anaesthetics have been approved in human studies, whereas dexamethasone microspheres have increased blockade duration in both human and animal studies [6][7][8][9]. Furthermore, dexamethasone has been shown to possess an anti-inflamatory action [10].…”