The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial

Abstract

Intravenous dexamethasone and dexmedetomidine, in conjunction with peripheral nerve blockade, have each been reported to prolong the duration of analgesia. This study tested whether combined use further prolongs analgesia duration after supraclavicular brachial plexus block (BPB) in patients undergoing orthopedic upper extremity surgery. One hundred twenty patients were randomized 1:1:1:1 to Control (saline bolus and midazolam infusion [0.05 mg/kg loading, 20 µg/kg/h thereafter]); DMED (saline bolus and dexmedetomidine infusion [1 μg/kg loading, 0.4 μg/kg/h thereafter]); DEXA (dexamethasone [10 mg] bolus and midazolam infusion); and DMED-DEXA (dexmedetomidine infusion and dexamethasone bolus) groups. The primary outcome was the duration of postoperative analgesia, defined as the time from the end of the BPB to the first dose of analgesia via a patient-controlled device. Median (interquartile range) times to first dose of analgesia in the Control, DMED, DEXA, and DMED-DEXA groups were 8.1 (6.2–11.6), 9.0 (8.1–11.3), 10.7 (8.1–20.5), and 13.2 (11.5–19.1) hours, respectively (p < 0.001). Pairwise comparisons showed significant prolongation of analgesia in the DEXA included groups compared with the non-DEXA included groups (DEXA vs. control, p = 0.045; DEXA vs. DMED, p = 0.045; DMED-DEXA vs. control, p < 0.001; DMED-DEXA vs. DMED, p < 0.001). A mixed effect model showed that dexamethasone was the only significant factor for the prolongation of analgesia (p < 0.001). Intravenous dexamethasone prolonged the analgesia duration of supraclavicular BPB after orthopedic upper extremity surgery. The concurrent use of mild to moderate sedation dose of intravenous dexmedetomidine in addition to intravenous dexamethasone showed no additional benefit to the prolongation of analgesia.

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

“…24 Block failure: presence of pinprick sensation in at least one neural distribution and/or need of another anesthetic technique to proceed surgery. 7,10,22 Duration of surgery: the time from incision to closure of skin.…”

“… 5 Nowadays ultrasound-guided brachial plexus block is a popular approach for upper limb surgeries as an alternative to general anesthesia. 6 – 8 From the different approaches to brachial plexus block, the supraclavicular approach is an easy and appropriate technique for anesthesia and analgesia in surgeries below the shoulder joint and this study evaluated it. 9 – 11 It provides greater analgesia, maintains stable intraoperative hemodynamics, reduces the stress response, and decreases anesthetic requirement and beneficial for the patients with various cardiorespiratory comorbidities.…”

Perioperative Hypotension in Patients Undergoing Orthopedic Upper Extremity Surgery with Dexmedetomidine Sedation: A Retrospective Study

“…In our previous study, we observed that dexmedetomidine sedation (at a mean dose of 1.6 µg/kg) significantly extended the duration of the blockade's analgesic effects by approximately 3 h [8]. However, we could not replicate this result in our subsequent study, where we used slightly reduced doses (mean of 1.1-1.2 µg/kg) [24]. In the meantime, in a recent cohort study, it was found that the risk of postoperative hypotension increased to about twice the baseline when the total intraoperative dexmedetomidine dose exceeded 50 µg [20].…”

Combined Dexamethasone and Dexmedetomidine as Adjuncts to Popliteal and Saphenous Nerve Blocks in Patients Undergoing Surgery of the Foot or Ankle: A Randomized, Blinded, Placebo-controlled Clinical Trial

“…Four trials assessed the combination versus dexmedetomidine alone, and all showed a greater duration of analgesia with the combination. [14][15][16][17] In two trials, the combination was shown to provide a greater duration of analgesia than placebo. 7,17 In line with the current trial, dexamethasone with dexmedetomidine provided a similar duration of analgesia as dexamethasone alone in two trials, 18,19 while one trial showed evidence of a greater duration with the combination.…”