Dexamethasone As Adjuvant in Supraclavicular Brachial Plexus Regional Anesthesia in Pediatric Patients
Date Issued
2023-03
Author(s)
Tijana Nastasovic
Abstract
Abstract: Introduction: Despite being one of the most efficient anesthetic techniques for upper
extremity surgery, supraclavicular brachial plexus blocks are uncommon in pediatric patients due to the
risk of possible complications like pneumothorax and local anesthetic toxicity. Blocks are more effective
when administered using ultrasound-guided techniques, which may also lower the risk of problems.
Adjuvants are frequently used in conjunction with local anesthetics to prolong the duration of the
sensory-motor block and reduce the total amount of local anesthetic required. Aim: The purpose of this
study is to compare the efficacy of supraclavicular brachial plexus blocks with bupivacaine 0.25% and
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bupivacaine o.25% with dexamethasone. Methods: Twenty consecutive patients admitted to our clinic
were randomly assigned to receive supraclavicular brachial plexus block with Bupivacaine 0.25%, o.3
ml/kg, or Bupivacaine 0.25%, 0.3 ml/kg, with 2 mg dexamethasone. Included were all patients with an
upper extremity fracture, aged 3 to 14 years, ASA II (American Society of Anesthesia Physical Status)-
eligible for supraclavicular brachial plexus, and I block regional anesthesia. Excluded were all patients
who refused regional anesthesia or had contraindications to receiving one, patients who received general
endotracheal anesthesia, patients with ASA III and IV, and patients scheduled for multiple surgeries.
Every five minutes, the sensory and motor blocks were evaluated to determine whether the entire arm
had reached an appropriate level of blockage. We evaluated the time for block performance, the duration
of analgesia, any complications, and the hospital stay. Results: Twenty patients, ranging in age from
three to fourteen years (mean 65 SD), were given supraclavicular brachial plexus block regional
anesthesia. Ten of them received only Bupivacaine 0.25% 0.3ml/kg, and 10 of them received
Bupivacaine 0.25% 0.3ml/kg with Dexamethasone 2mg. The mean onset of sensory block was faster in
the dexamethasone group (245 seconds), along with motor block (495 seconds). Block lasted longer in
the dexamethasone group. The mean analgesia time was longer in the dexamethasone group (14 hours).
There were no complications observed during this evaluation. The average hospital stay was one day.
Conclusion: In comparison to using bupivacaine alone, adding dexamethasone to the supraclavicular
brachial plexus block speeds up the start of the sensory and motor block and lengthens the duration of
analgesia.
extremity surgery, supraclavicular brachial plexus blocks are uncommon in pediatric patients due to the
risk of possible complications like pneumothorax and local anesthetic toxicity. Blocks are more effective
when administered using ultrasound-guided techniques, which may also lower the risk of problems.
Adjuvants are frequently used in conjunction with local anesthetics to prolong the duration of the
sensory-motor block and reduce the total amount of local anesthetic required. Aim: The purpose of this
study is to compare the efficacy of supraclavicular brachial plexus blocks with bupivacaine 0.25% and
| 229
bupivacaine o.25% with dexamethasone. Methods: Twenty consecutive patients admitted to our clinic
were randomly assigned to receive supraclavicular brachial plexus block with Bupivacaine 0.25%, o.3
ml/kg, or Bupivacaine 0.25%, 0.3 ml/kg, with 2 mg dexamethasone. Included were all patients with an
upper extremity fracture, aged 3 to 14 years, ASA II (American Society of Anesthesia Physical Status)-
eligible for supraclavicular brachial plexus, and I block regional anesthesia. Excluded were all patients
who refused regional anesthesia or had contraindications to receiving one, patients who received general
endotracheal anesthesia, patients with ASA III and IV, and patients scheduled for multiple surgeries.
Every five minutes, the sensory and motor blocks were evaluated to determine whether the entire arm
had reached an appropriate level of blockage. We evaluated the time for block performance, the duration
of analgesia, any complications, and the hospital stay. Results: Twenty patients, ranging in age from
three to fourteen years (mean 65 SD), were given supraclavicular brachial plexus block regional
anesthesia. Ten of them received only Bupivacaine 0.25% 0.3ml/kg, and 10 of them received
Bupivacaine 0.25% 0.3ml/kg with Dexamethasone 2mg. The mean onset of sensory block was faster in
the dexamethasone group (245 seconds), along with motor block (495 seconds). Block lasted longer in
the dexamethasone group. The mean analgesia time was longer in the dexamethasone group (14 hours).
There were no complications observed during this evaluation. The average hospital stay was one day.
Conclusion: In comparison to using bupivacaine alone, adding dexamethasone to the supraclavicular
brachial plexus block speeds up the start of the sensory and motor block and lengthens the duration of
analgesia.
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