Supraclavicular Brachial Plexus Block With or Without Dexamethasone as an Adjuvant to 0.5% Levobupivacaine: A Comparative Study

Baloda, Ritu; Bhupal, J. P. S.; Kumar, Parmod; Gandhi, Gurjit Singh

doi:10.7860/jcdr/2016/18325.8048

Cited by 10 publications

(18 citation statements)

References 8 publications

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“…In a comparative study of adjuvants such as midazolam and epinephrine, use of dexamethasone (8 mg) with bupivacaine (30 mL) not only produced rapid onset of sensory and motor block but also delayed the demand of rescue analgesia. [20] Both the above studies[1920] were in complete agreement with ours. Studies were divided regarding the optimum dose of dexamethasone as an adjuvant to local anaesthetics and its impact on the onset of block.…”

Section: Discussionsupporting

confidence: 90%

“…In another study, the addition of 8 mg of dexamethasone to 30 mL of levobupivacaine reduced the onset of sensory and motor block and provided prolonged analgesia in supraclavicular brachial plexus block by paraesthesia technique. [ 19 ] In contrast to this study, 25 mL of levobupivacaine was deemed appropriate for our study in view of ultrasound guided SCBP block. In a comparative study of adjuvants such as midazolam and epinephrine, use of dexamethasone (8 mg) with bupivacaine (30 mL) not only produced rapid onset of sensory and motor block but also delayed the demand of rescue analgesia.…”

Section: Discussionmentioning

confidence: 97%

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A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

et al. 2017

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Background and Aims:Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, the effect of dexamethasone (8 mg) when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in SCBP block.Methods:Ultrasound- guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi-square test and Student's t-test were used for statistical analysis.Results:Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S.Conclusion:The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

et al. 2017

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“…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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“…The addition of dexamethasone to regional anesthetics such as lidocaine, bupivacaine, and other sodium channelblocking anesthetics has been shown to prolong the duration of analgesia. 5,11,[32][33][34][35][36][37] Recently, a meta-analysis of nine randomized trials by Choi et al 1 found that the addition of dexamethasone to regional anesthetics prolongs the duration of analgesia by approximately six hours. Furthermore, they reported a trend towards decreased opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

Hussain

Langenbergh

Sermer

et al. 2017

Can J Anesth/J Can Anesth

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Supraclavicular Brachial Plexus Block With or Without Dexamethasone as an Adjuvant to 0.5% Levobupivacaine: A Comparative Study

Cited by 10 publications

References 8 publications

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

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

Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

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