Document Detail


Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade.
MedLine Citation:
PMID:  20009936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. However, it has not been evaluated when given in conjunction with bupivacaine and clonidine to provide blockade of the brachial plexus at the interscalene level. The purpose of this investigation was to determine whether the addition of dexamethasone to interscalene brachial plexus block would prolong the duration of sensory analgesia in a group of patients undergoing outpatient shoulder arthroscopy. METHODS: This prospective, randomized, double-blind investigation was performed on 88 individuals undergoing shoulder arthroscopy. Patients received interscalene brachial plexus block using 20 ml of bupivacaine 5 mg ml(-1) with 1: 200,000 epinephrine and clonidine 75 microg. Patients were randomly assigned to receive either dexamethasone 8 mg or 0.9% NaCl as an adjuvant to the mixture. After discharge, patients recorded pain scores and analgesic consumption in a diary and estimated the time at which they perceived that the sensory block from the interscalene brachial plexus block resolved. This was based on pain, recovery of sensation and strength in the arm. Variables measured included demographics, timed pain intensity measurements, postoperative analgesic consumption, duration of analgesia and patient satisfaction. RESULTS: Dexamethasone prolonged median sensory (1457 vs. 833 min, P < 0.0001) and motor (1374 vs. 827 min, P < 0.0001) blockade compared with the control. At 24 h, the dexamethasone group had lower median verbal analogue scale scores compared with control (3.0 vs. 6.0). At 48 h, the two groups had similar median pain scores (4.0 vs. 5.0, dexamethasone vs. control, respectively). The opioid requirement in oxycodone equivalency was lower in the dexamethasone group than in the control group for the first 24 h, and similar thereafter. Median patient satisfaction scores were not significantly different between the two groups at 48 h (9.5 vs. 8.0, dexamethasone vs. control, respectively). CONCLUSION: The addition of dexamethasone to a bupivacaine-epinephrine-clonidine interscalene block prolongs sensory block and reduces opioid use.
Authors:
Peter A Vieira; Istvan Pulai; George C Tsao; Poornachandran Manikantan; Brunella Keller; Neil Roy Connelly
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  27     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-09     Completed Date:  2010-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  285-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia / methods*
Brachial Plexus / drug effects,  surgery*,  ultrasonography*
Bupivacaine / administration & dosage*
Dexamethasone / administration & dosage*
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Nerve Block / methods*
Pain, Postoperative / etiology,  prevention & control
Prospective Studies
Time Factors
Ultrasonography, Interventional / methods*
Chemical
Reg. No./Substance:
2180-92-9/Bupivacaine; 50-02-2/Dexamethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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