Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery

Abstract

Aim: The study conducted aims to assess the efficacy, time to first analgesic request, and postoperative inflammatory response after adding dexamethasone to local anesthetic mixture for a peribulbar block in posterior segment eye surgery. Patients and methods: A double-blind randomized study was carried out on 50 ASA I and II patients scheduled for elective posterior segment surgery (vitreoretinal). Patients were allocated randomly into two groups, 25 patients in each group. Group I received equal volumes of 10 ml of a l:1 mixture of bupivacaine 0.5% and saline, supplemented with 4 mg dexamethasone in 1 ml saline and group II received the same local anesthetic mixture (total volume 10 ml) without adding dexamethasone. The duration and onset of motor block, time to first analgesic request, postoperative inflammatory response, and other side effects such as nausea and vomiting were assessed. Results: Patients receiving peribulbar block were significantly pain free by end of surgery (0 h) (P < 0.05) and throughout the postoperative period in the dexamethasone group at 2 and 6 h postoperatively. The number of patients requiring rescue analgesics was significantly lower with dexamethasone bupivacaine block (P < 0.05). The incidence of postoperative nausea and vomiting was significantly less in the first group (I) in comparison to the other group (II) (P < 0.05) and lastly the level of C reactive protein postoperatively was found to be significantly less in the dexamethasone group than the other one (P < 0.0001). Conclusion: Adding dexamethasone to bupivacaine in peribulbar block appears to be a safe and clinically superior adjuvant with less postoperative pain, inflammatory response in patients undergoing posterior segment eye surgery.

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].…”

The effect of adding dexmedetomidine to local anesthetic mixture for peribulbar block in vitreoretinal surgeries

“…Many adjuvants were tried before to help to improve the potency of the block and increase the duration of analgesia and akinesia intra-and post-operatively [1,2].…”

Dexamethasone compared to dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar block for vitreoretinal surgery. A prospective randomized study

“…The results of this study were consistent with Mahmoud et al . [ 14 ] who studied the effect of adding dexamethasone 4 mg to bupivacaine 0.5% versus bupivacaine 0.5% without additives for peribulbar block in vitreoretinal surgeries; they demonstrated longer duration of lid and globe akinesia, delayed onset of first rescue analgesia, fewer number of patients requiring rescue medications, as well as decreased inflammatory response to surgery in dexamethasone group compared to bupivacaine group. In addition, no statistically significant difference was detected between the two groups as regards the onset of lid and globe akinesia, and they attributed this finding to the delayed onset of action of dexamethasone which starts after 1–2 h of its administration.…”

“…To our knowledge, only two studies have evaluated the combination of dexamethasone with local anesthetics in eye procedures with no previous published researches comparing between dexamethasone and dexmedetomidine in that framework. [ 14 31 ]…”