Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries
Keywords:Dexamethasone, Levobupivacaine, Postoperative analgesia, Supraclavicular brachial plexus block, Upper extremity surgery
Background: The supraclavicular brachial plexus block has proven to be an important, safer and effective alternative to general anaesthesia in surgeries of upper extremity. Primary aim is to study the effect of addition of dexamethasone to levobupivacaine on postoperative analgesia and secondary objectives are to study onset, peak effect and duration of sensory and motor block in brachial plexus blockade in adult patients posted for upper limb surgeries
Methods: This prospective randomized clinical study was conducted on 60 patients of age 18 to 60 years posted for upper limb surgeries. They were randomly allocated into two groups of 30. In Control group LS (n=30) received Inj. Levobupivacaine 30ml and Inj. Normal saline 2ml. In Study group LD (n=30) received Inj. Levobupivacaine 30ml and Inj. Dexamethasone 2ml (8mg).
Results: Both the groups were demographically comparable. Onset of sensory block and motor block in group LD and in group LS were similar (p>0.05). Mean duration of sensory and motor block in group LD was higher than in group LS (<0.001). Duration of postoperative analgesia was 21.20±3.23 hours in group LD and 10.24±1.57 hours in group LS (p<0.001).
Conclusions: Dexamethasone added to levobupivacaine for brachial plexus block prolonged the duration of sensory, motor blockade and postoperative analgesia but did not alter the onset time, peak effect time of sensory and motor blockade.
Kulenkampff D. Brachial Plexus Anaesthesia. Ann Surg. 1928;87(6):883-91.
Cousins M, Bridenbaugh P, Lippincott P. Neural Blockade in Clinical Anaesthesia and Management of Pain. Anaesthesiology. 1981;55(4):490-4.
Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without dexamethasone – a comparative study. Inter J Scien Rese Pub. 2012;2(12):1-7.
Honorio T. Benzon, Epidural Steroids: In P. Prithvi Raj. Pain medicine, a comprehensive review. Maryland Heights, Missouri; Mosby publications. 1999:259-63.
Gristwood R, Greaves J. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert Opinion on Investigational Drugs. 1999;8(6):861-6.
Mazoit J, Boico O, Samii K. Myocardial Uptake of Bupivacaine. Anaesthesia & Analgesia. 1993;77(3):477-82.
Santos ADeArmas P. Systemic Toxicity of Levobupivacaine, Bupivacaine, and Ropivacaine during Continuous Intravenous Infusion to Nonpregnant and Pregnant Ewes. Anaesthesiology. 2001;95(5):1256-64.
Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade. Anaesthesia & Analgesia. 2006;102(1):263-7.
Biradar P, Kaimar P, Gopalakrishna K. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study. Indian J Anaes. 2013;57(2):180-4.
Persec J, Persec Z, Kopljar M, Zupcic M, Sakic L, Zrinjscak I et al. Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade. International Orthopaedics. 2013;38(1):101-5.
Shrestha BR, Maharjan SK, Tabedar S, Supraclavicular brachial plexus block with and without dexamethasone – A comparative study Kathmandu Univ Med J. 2003;(1):158-60.
Kim Y, Lee G, Kim D, Kim C, Baik H, Heo S. Dexamathasone added to levobupivacaine improves postoperative analgesia in ultrasound guided interscalene brachial plexus blockade for arthroscopic shoulder surgery. Korean J Anaesthes. 2012;62(2):130-4.
Stan T, Goodman E, Cardida B, Curtis RH. Adding methylprednisolone to local anaesthetic increases the duration of axillary block. Reg Anaesth Pain Med. 2004;29:380-1.
Attardi B, Takimoto K, Gealy R, Severns C, Levitan ES: Glucocorticoid induced upregulation of a pituitary K+ channel mRNA in vitro and in vivo. Receptors Channels. 1993;1:287-93.
Fredrickson Fanzca MJ, Danesh-Clough TK, White R. Adjuvant dexamethasone for bupivacaine sciatic and ankle blocks: results from 2 randomized placebo-controlled trials. Reg Anesth Pain Med. 2013;38(4):300-7.
Rahangdale R, Kendall MC, McCarthy RJ, Tureanu L, Doty Jr R, Weingart A, De Oliveira Jr GS. The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study. Anesthesia and Analgesia. 2014;118(5):1113-9.