Dexamethasone as an adjuvant to bupivacaine in brachial plexus block in upper limb surgery

Abstract

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Supraclavicular brachial plexus block is widely used for surgery below shoulder joint. Adding adjuvant to local anesthetic drugs enhance the duration of block as well as postoperative analgesia. Dexamethasone very potent glucocorticoid when added to local significantly prolongs the duration of analgesia</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This randomized, single blind, controlled study include 100 patients of either sex, aged 18–60 years, ASA status I–III, undergoing upper limb surgery were randomly allocated to receive either 0.375% 30 cc bupivacaine with 2 ml normal saline (group C, n=50) or 0.375% bupivacaine with 2 ml (8 mg) dexamethasone (group D, n=50). The observed parameters include onset and duration of motor and sensory block, duration of effective analgesia any side effects and hemodynamic (pulse rate, NIBP, SpO2). </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Mean onset time of sensory and motor block in group C was significantly longer as compared to group D. (p<0.0001) The duration of sensory and motor blockade was significantly prolonged in group D compared to group C. (p<0.0001) The duration of effective analgesia was also significantly prolonged in group D (931.2±69.88 mins) compared to group C (454.8±34.47 mins) (p<0.0001)</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Addition of dexamethasone to 0.375% bupivacaine in brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade. It also prolongs the duration of effective analgesia. </span></p>

Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

“…For motor block duration, 23 studies were judged to be at low risk of bias [32, 35, 38, 39, 42, 45, 53, 54, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 67 studies were at some risk of bias [33, 34, 36, 37, 40, 43, 48, 50–52, 55, 57, 58, 60–62, 67, 68, 70–75, 77–80, 83–91, 95–106, 108, 109, 111, 114, 117–126, 128–131] and 3 studies were at high risk of bias [41, 63, 127]. The provision of inadequate detail about randomisation and allocation concealment was the most common reason for downgrading the rating, followed by concerns relating to outcome measurement.…”

“…Consequently, these arms yielded estimates from indirect comparisons only. Ninety‐three trials with 5668 patients examined motor block duration [32–43, 45, 48, 50–63, 65, 67, 68, 70–111, 113–131] (Fig. 2).…”

“…For the primary outcome, sensory block duration, 20 studies were judged to have a low risk of bias [35, 38, 39, 42, 45, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 61 studies had some risk of bias [33, 34, 36, 37, 43, 47, 48, 52, 55, 57, 58, 61, 67, 68, 70, 71, 73–75, 77–80, 83–85, 87–91, 95–106, 108, 109, 111, 114, 117–123, 125–131] and 4 studies were at high risk of bias [41, 63, 86, 124].…”

“…We included 93 trials (n = 5668) in the network meta‐analysis for motor block duration [32–43, 45, 48, 50–63, 65, 67, 68, 70–111, 113–131]. The mean (95%CI) duration of motor block in the control group was 369 (330‐408) min.…”

A comparative study of dexamethasone versus midazolam as adjuvant to 0.5% bupivacaine in ultrasound-guided supraclavicular brachial plexus block for upper-limb surgeries

“…Engineer et al . [ 12 ] found that dexamethasone, when added to bupivacaine, increased the duration of sensory and motor blocks and duration of effective analgesia. The duration of analgesia was more in this study compared to our study, probably due to the use of higher volume of bupivacaine.…”