The Effects of Dexamethasone and Potassium Chloride as Additives to Local Anaesthetic in Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Reghunathan, Ushakumary; Veetil, Bindu Mele; Raghavan, Radha Korumbil; Thodi, Ausaf Ashik Karikannan

doi:10.14260/jemds/2016/812

Cited by 2 publications

(5 citation statements)

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“…The full‐text manuscripts of the remaining 312 studies were assessed. After including studies from hand searches and revision of search, we identified a total of 100 studies for inclusion in this network meta‐analysis [32–131]. The study flow chart is in online Supporting Information Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐eight articles were peer‐reviewed and indexed trials [32, 34, 36–38, 42, 44, 53, 54, 58, 59, 63, 66, 69, 72, 75, 79, 81–84, 94, 96, 99, 102, 105, 107, 109, 110, 113–116, 123, 124, 127–129], while 62 articles were peer‐reviewed, non‐indexed publications [33, 35, 39–41, 43, 45–52, 55–57, 60–62, 64, 65, 67, 68, 70, 73, 74, 76–78, 80, 83, 85–93, 95, 97, 98, 100, 101, 103, 104, 106, 108, 111, 112, 117–122, 125, 126, 130, 131]. Fifty‐four trials used bupivacaine as their long‐acting local anaesthetic [32–35, 38, 40–44, 46–48, 50, 51, 54, 55, 57–59, 61, 62, 64–66, 68–72, 76, 77, 79, 85, 89–91, 93, 94, 98–101, 103, 104, 106, 112, 116–118, 122, 124–126], 14 used levobupivacaine [37, 45, 63, 73, 78, 82, 83, 86, 87, 97, 109, 111, 115, 121] and 32 used ropivacaine […”

Section: Resultsmentioning

confidence: 99%

“…Fifty‐four trials used bupivacaine as their long‐acting local anaesthetic [32–35, 38, 40–44, 46–48, 50, 51, 54, 55, 57–59, 61, 62, 64–66, 68–72, 76, 77, 79, 85, 89–91, 93, 94, 98–101, 103, 104, 106, 112, 116–118, 122, 124–126], 14 used levobupivacaine [37, 45, 63, 73, 78, 82, 83, 86, 87, 97, 109, 111, 115, 121] and 32 used ropivacaine [36, 38, 39, 49, 52, 53, 56, 60, 67, 74, 75, 80, 81, 84, 88, 92, 95, 96, 102, 105, 107, 108, 110, 113, 114, 119, 120, 123, 127–131]. Twenty‐three trials used lidocaine in the local anaesthetic admixture [33, 41, 44, 46–48, 50, 51, 57, 62, 64, 66, 69, 89, 90, 98, 99, 101, 104, 112, 113, 115, 124], while 15 added epinephrine to the local anaesthetic [41, 42, 44, 47, 48, 51, 57, 62, 66, 69, 89, 90, 112, 113, 124].…”

Section: Resultsmentioning

confidence: 99%

“…126,130,131]. Fifty-four trials used bupivacaine as their long-acting local anaesthetic[32-35, 38, 40-44, 46-48, 50, 51, 54, 55, 57-59, 61, 62, 64-66, 68-72, 76, 77, 79, 85, 89- 91, 93, 94, 98-101, 103, 104, 106, 112, 116-118, 122, 124- 126], 14 used levobupivacaine[37, 45, 63, 73, 78, 82, 83, 86, Twenty-three trials used lidocaine in the local anaesthetic admixture[33, 41, 44, 46-48, 50, 51, 57, 62, 64, 66, 69, 89, 90, 98, 99, 101, 104, 112, 113, 115, 124], while 15 added epinephrine to the local anaesthetic[41,42,44,47,48,51,57,62,66,69,89,90,112,113,124]. 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].Figure 1Similarly, pairwise meta-analysis of 53 trials for sensory block duration[73-111, 113-122, 125, 126, 128, 129] and 53 trials for motor block duration[73-111, 113- 122, 125, 126, 128, 129] comparing perineural dexmedetomidine vs. control arms did not reveal any sub-group differences by indexing status (see online Supporting Information).…”

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2020

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“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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The Effects of Dexamethasone and Potassium Chloride as Additives to Local Anaesthetic in Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Cited by 2 publications

References 12 publications

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

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

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

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