Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study

Parveen, Shabana; Jan, Masrat; Taj, Arshi; Bhat, Arif Akbar

doi:10.18203/2320-6012.ijrms20171858

Cited by 5 publications

(13 citation statements)

References 11 publications

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“…6 The duration of motor block was prolonged in dexamethasone bupivacaine group when compared to bupivacaine alone group (778.54 ± 235.50 vs 435.39 ± 179.82, respectively) in minutes, p -value < 0.001. This was supported by Parveen S et al.’s 16 study, even though the duration of motor block was shorter than our result.…”

Section: Discussionsupporting

confidence: 89%

“…8 , 11 Varies studies have tried different doses of dexamethasone, 19 but most of previous studies used 8 mg dexamethasone with higher doses of bupivacaine. 5 , 6 , 8 , 16 , 20 Few researchers have studied dexamethasone with low-dose low-volume of bupivacaine; 4 , 14 however, low-volume of bupivacaine compromised the duration of analgesia in ultrasound-guided supraclavicular brachial plexus blocks. 17 To prolong postoperative analgesia whether to use dexamethasone with a low-dose low-volume or low-dose high-volume of bupivacaine is being studied.…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED: The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study

2022

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Objectives: To compare the postoperative analgesia efficacy of dexamethasone added to low-dose high-volume bupivacaine in ultrasound-guided supraclavicular brachial plexus block for adult patients who underwent upper limb orthopedic surgeries at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Methods: An observational prospective cohort study was conducted from 1 September 2021 to 30 January 2022. Using a systematic random sampling technique, 56 patients (equal groups of 28 patients) aged 18–60 years scheduled for elective upper limb orthopedic surgeries under supraclavicular block were recruited. According to the discretion of anesthetists’ management plan of supraclavicular block, those patients who received 38 mL of 0.25% bupivacaine with 2 mL (8 mg) dexamethasone as the case group (DB) while those patients who received 40 mL of 0.25% bupivacaine alone as the cohort group (B). Time to first analgesic request, onset of sensory and motor, and motor block duration were analyzed with Student’s t-test whereas pain severity and analgesic consumption were assessed using the Mann–Whitney U test. Categorical variables were analyzed using chi-square test. p-value less than 0.05 considered statistically significant. Results: Postoperative analgesia had significantly prolonged in the dexamethasone bupivacaine group with a mean duration of 1098.00 ± 195.90 min compared to 464.29 ± 113.75 min in the bupivacaine alone group, p-value < 0.001. Moreover, the dexamethasone bupivacaine group significantly consumed less total tramadol and diclofenac than bupivacaine alone, with a median dose of 0 (0–50) versus 50 (21.25–78.75) mg and 40 (0–50) versus 65 (47.50–77.50) mg, respectively. The median visual analogue scale scores were significantly reduced at 6th, 8th, 12th, and 24th hour in the dexamethasone bupivacaine group. Conclusion: Dexamethasone added to low-dose high-volume of bupivacaine in supraclavicular brachial plexus block significantly prolonged the duration of analgesia.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

RETRACTED: The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study

2022

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“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

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“…[ 5 ] Ultrasound-guided block is a safe and reliable technique of regional anesthesia in patients undergoing upper-limb surgeries. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Background: Ultrasound has been effective in using low volume of local anesthetics for supraclavicular block. Steroids have been shown to increase the duration of local anesthetics. Aims and Objectives: In this study, we compare the efficacy of dexamethasone versus midazolam when added to bupivacaine in supraclavicular brachial plexus block for upper-limb surgeries with regard to the time of onset and duration of sensory and motor blockades, duration of analgesia, sedation, and hemodynamic parameters. Setting and Design: This is a prospective, randomized, double-blind study conducted on 60 patients belonging to the American Society of Anesthesiologists physical status classes 1 and 2, undergoing upper-limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: Sixty patients were divided into two groups of 30 each. Group dexamethasone (Group D) received bupivacaine 0.5% 18 mL + dexamethasone 4 mg + 1 mL normal saline. Group midazolam (Group M) received bupivacaine 0.5% 18 mL + 2 mg midazolam. We compared the onset and duration of sensory and motor blocks, hemodynamic variables, pain and sedation scores, and duration of analgesia. Statistical Analysis: The statistical software, namely SPSS 18.0 and R environment ver. 3.2.2, were used for the analysis of the data. P < 0.05 was considered statistically significant. Results: The onset of sensory and motor blocks was significantly faster in Group D compared to Group M. The duration of sensory and motor blockades and duration of analgesia showed a significant increase in Group D in comparison with Group M. Conclusion: Dexamethasone as an adjuvant hastens the onset and prolongs the duration of both sensory and motor blocks and reduces postoperative analgesic requirement when compared to midazolam.

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Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study

Cited by 5 publications

References 11 publications

RETRACTED: The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study

RETRACTED: The postoperative analgesia efficacy of dexamethasone added to bupivacaine versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block for upper limb orthopedic surgeries, Ethiopia: An observational prospective cohort study

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

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

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