The Effects of Magnesium Sulfate and Dexamethasone as Additives to Local Anaestheticin Supraclavicular Block a Randomised Controlled Study

Abstract

BACKGROUND The aim of this study was to evaluate the effects of dexamethasone and magnesium sulfate as additives to local anaesthetic solution containing lignocaine and bupivacaine in supraclavicular brachial plexus block. MATERIALS AND METHODS A prospective randomised double blind control study was conducted on 90 healthy patients of ASA grade I, II of age group 18-50 years scheduled for upper limb surgeries under supraclavicular block. Patients were allocated to three groups of 30 each as a control group (S) received only local anaesthetic, group getting dexamethasone as additive (SD) and group getting magnesium sulfate as additive to local anaesthetics (SM).Parameters observed were time of onset of sensory and motor block, duration of analgesia and side effects. RESULTS Onset of sensory block was most rapid in Group SD and was statistically significant when compared to Group S (p<0.01) and Group SM (p<0.01). The meantime for sensory block onset was 11.07 ± 2.033 mins in Group S, 6.80 ± 2.384 minutes in Group SD and 8.70± 1.896 minutes in Group SM. Mean time for onset of motor block in Group S, Group SM, and Group SD was 13.17± 2.66 minutes, 10.27± 2.39 minutes and 9.40 ± 2.29 mins respectively. Onset of motor block was earliest in Group SD and this was statistically significant when compared to Group S (p<0.01) but statistically insignificant (p=0.526) between Group SD and Group SM. Duration of analgesia was found to be highest in Group SD with mean duration of analgesia (738.33 ± 187.69 minutes) and in Group S it was (308.33 ± 60.05 minutes) and Group SM was 628.02 ± 182.06 minutes. It was statistically significant when compared to Group S (p<0.01) and Group SM (p<0.01).

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

“…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.…”

“…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].…”

“…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 […”

The Use of Magnesium Sulfate and Peripheral Nerve Blocks

“…Our literature search identified 578 studies, including 21 eligible RCTs and 1323 patients that met the study inclusion criteria (Table 1). [5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In total, 557 studies were rejected for the following reasons: 537 were not RCTs, 7 were reviews, 4 included animal experiments, 2 lacked a control group, and 7 investigated local anesthesia without nerve block. Table 1 summarizes all relevant patient characteristics and specific treatment methods.…”

“…Table 1 summarizes all relevant patient characteristics and specific treatment methods. Eight studies [5][6][7]15,19,[25][26][27] assessed the role of magnesium sulfate as an adjuvant in brachial plexus blockade, 6 [12][13][14]16,17,24 in femoral or sciatic nerve blockade, 4 11,18,21,22 in TAP block, and 3 8,20,23 assessed its role in thoracic or intercostal nerve blockade.…”