Does the addition of dexamethason to local anesthetic prolong the analgesia of interscalen plexus brachialis block in patients with shoulder surgery?

Abstract

Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost andmostcompleteanesthesia withsatisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASAI-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach andmixtureof2%lidocaine(12ml)and0.5%bupivacaine (22 ml) either alone or combined with dexamethasone (4 mg). The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2(with dexamethasone) as compared to Group G1 patients (p < 0.01). Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and cost effective method of providing postoperative analgesia.