Comparative Study of the first Request for Rescue Analgesia and the Total Analgesic Requirement Postoperatively in Brachial Plexus Block with and without Dexamethasone as an Adjunct to Ropivacaine
Creators
- 1. Associate Professor, Department of Anaesthesiology and Critical Care, FAAMCH, Barpeta, Assam
- 2. Registrar, Department of Anaesthesiology and Critical Care, FAAMCH, Barpeta, Assam
- 3. Assistant Professor, Department of Anaesthesiology and Critical Care, FAAMCH, Barpeta, Assam
Description
Introduction: A brachial plexus block is the most preferred procedure for upper limb surgeries. Adjuncts, when given with local anaesthetics, prolong the analgesic efficacy of the block. The aim is to compare patients receiving supraclavicular brachial plexus block with and without perineural dexamethasone to the following: 1. First request for IV rescue analgesia. 2. Total post-operative IV analgesic consumption within 24 hours. Methods: Sixty patients with physical status ASA I and II, aged 18 to 50 years of both sexes, were randomly allocated into two groups of thirty. Group A received a supraclavicular block with 0.5% ropivacaine (30 ml) and 1ml(4mg) dexamethasone perineurally and 1ml 0.9%normal saline intravenously. Group B received a supraclavicular block with 0.5% ropivacaine(30ml) and 1ml 0.9%normal saline perineurally and 1 ml (4mg) dexamethasone intravenously. The duration of the sensory blockade was noted in both groups. Results: The duration of analgesia in group A was found to be longer than in group B. The time for rescue analgesia in group A was 874.87 ±41.09 min compared to group B’s 615.17 ±39.69 min, with a p-value of 0.001. And the average consumption of analgesic (Inj. Tramadol-1 mg/kg) post-operatively up to 24 hours in group A (86.7 ±31.60 mg) was less than that in group B (151.4 ±32.66 mg). Conclusions: In supraclavicular brachial plexus block, dexamethasone given as adjuvant perineurally significantly delays the time of first request of intravenous rescue analgesia and decreases the total postoperative intravenous analgesic requirement.
Abstract (English)
Introduction: A brachial plexus block is the most preferred procedure for upper limb surgeries. Adjuncts, when given with local anaesthetics, prolong the analgesic efficacy of the block. The aim is to compare patients receiving supraclavicular brachial plexus block with and without perineural dexamethasone to the following: 1. First request for IV rescue analgesia. 2. Total post-operative IV analgesic consumption within 24 hours. Methods: Sixty patients with physical status ASA I and II, aged 18 to 50 years of both sexes, were randomly allocated into two groups of thirty. Group A received a supraclavicular block with 0.5% ropivacaine (30 ml) and 1ml(4mg) dexamethasone perineurally and 1ml 0.9%normal saline intravenously. Group B received a supraclavicular block with 0.5% ropivacaine(30ml) and 1ml 0.9%normal saline perineurally and 1 ml (4mg) dexamethasone intravenously. The duration of the sensory blockade was noted in both groups. Results: The duration of analgesia in group A was found to be longer than in group B. The time for rescue analgesia in group A was 874.87 ±41.09 min compared to group B’s 615.17 ±39.69 min, with a p-value of 0.001. And the average consumption of analgesic (Inj. Tramadol-1 mg/kg) post-operatively up to 24 hours in group A (86.7 ±31.60 mg) was less than that in group B (151.4 ±32.66 mg). Conclusions: In supraclavicular brachial plexus block, dexamethasone given as adjuvant perineurally significantly delays the time of first request of intravenous rescue analgesia and decreases the total postoperative intravenous analgesic requirement.
Files
IJPCR,Vol15,Issue6,Article207.pdf
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Additional details
Dates
- Accepted
-
2023-06-05
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue6,Article207.pdf
- Development Status
- Active
References
- 1. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomised controlled trials. The Journal of the American Society of Anesthesiologists. 2011 Sep 1;115(3):575- 88. 2. McCartney C, Choi S. Analgesic Adjuvants in the Peripheral Nervous System. In: Hadzic A, ed. Hadzic's textbook of regional anesthesia and acute pain management. 2nd ed. McGraw Hill Education; 2017:147-154. 3. Parveen S, Athaluri VV, Lakshmi BS. Effect of intravenous dexamethasone in prolonging the duration of supraclavicular brachial plexus block with 0.5% ropivacaine: A BIBLIOGRAPHY Page 126 prospective, randomized, placebo-controlled study. International Journal of Scientific Study. 2015;2(10):56-60. 4. Duncan M, Shetti AN, Tripathy DK, Roshansingh D, Krishnaveni N. A comparative study of nerve stimulator versus ultrasound-guided supraclavicular brachial plexus block. Anesthesia, essays and researches. 2013 Sep;7(3):359. 5. Parrington SJ, O'Donnell D, Chan VW, Brown-Shreves D, Subramanyam R, Qu M, Brull R. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Regional Anesthesia & Pain Medicine. 2010 Aug 1;35(5):422-26. 6. Dar FA, Najar MR, Jan N. Effect of addition of dexamethasone to ropivacaine in supraclavicular brachial plexus block. Indian Journal of Pain. 2013 Sep 1;27(3):165. 7. Godbole MR, Karhade SS, Parihar PP. A prospective study of comparison of analgesic efficacy of dexamethasone as an adjuvant in supraclavicular block with intravenous dexamethasone after supraclavicular block in patients undergoing forearm surgeries. Anesthesia, essays and researches. 2019 Jan;13(1):31. 8. Mathew R,Radha KR, Hema VR. Effect of perineural and intravenous dexamethasone on duration of analgesia in supraclavicular brachial plexus block with bupivacaine: a comparative study. Anesthesia, essays and researches. 2019 Apr;13(2):280. 9. Aliste J, Leurcharusmee P, Engsusophon P, Gordon A, Michelagnoli G, Sriparkdee C, Tiyaprasertkul W, Tran DQ, Van Zundert TC, Finlayson RJ, Tran DQ. A randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided axillary block. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2017 Jan;64(1):29-36. 10. Kawanishi R, Yamamoto K, Tobetto Y, Nomura K, Kato M, Go R, Tsutsumi YM, Tanaka K, Takeda Y. Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial. Local and regional anesthesia. 2014; 7:5. 11. Frawley G, Smith KR, Ingelmo P. Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia. British journal of anaesthesia. 2009 Nov 1;103(5):731-8. 12. Rosenfeld DM, Ivancic MG, Hattrup SJ, Renfree KJ, Watkins AR, Hentz JG, Gorlin AW, Spiro JA, Trentman TL. Perineural versus intravenous dexamethasone as adjuncts to local anaesthetic brachial plexus block for shoulder surgery. Anaesthesia. 2016 Apr;71(4):380- 8. 13. De Oliveira GS, Castro Alves LJ, Nader A, Kendall MC, Rahangdale R, McCarthy RJ. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. Pain research and treatment. 2014 Oct;2014. 14. Abdallah FW, Johnson J, Chan V, Murgatroyd H, Ghafari M, Ami N, Jin R, Brull R. Intravenous dexamethasone and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block: a randomized, triple-arm, doubleblind, placebo-controlled trial. Regional Anesthesia & Pain Medicine. 2015 Mar 1;40(2):125-32