EPINEPHRINE AND DEXAMETHASONE AS ADJUVANTS IN UPPER EXTREMITY PERIPHERAL NERVE BLOCKS IN PEDIATRIC PATIENTS
Journal
Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)
Date Issued
2021
Author(s)
Ljubica Mikjunovikj-Derebanova
Ljupcho Donev
Albert Lleshi
Marija Toleska
Aleksandar Dimitrovski
Vasko Demjanski
Abstract
ABSTRACT
Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased
interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the
anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting
the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric
population is still under research.
Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral
upper extremity nerve blocks in pediatric patients.
Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University
Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020
until March 2021. Patients were randomized into three groups, and all patients in the groups received
analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular,
or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of
0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine
and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21)
received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone
with a total volume of 0.5ml/kg.
Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours,
while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations
of both sensory and motor block were prolonged for about 30 minutes on average compared to the first
group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer
compared with the first two groups (p<0.0001).
Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in pe-
ripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics
in the postoperative period.
Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased
interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the
anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting
the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric
population is still under research.
Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral
upper extremity nerve blocks in pediatric patients.
Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University
Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020
until March 2021. Patients were randomized into three groups, and all patients in the groups received
analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular,
or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of
0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine
and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21)
received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone
with a total volume of 0.5ml/kg.
Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours,
while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations
of both sensory and motor block were prolonged for about 30 minutes on average compared to the first
group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer
compared with the first two groups (p<0.0001).
Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in pe-
ripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics
in the postoperative period.