Dexamethasone as an adjuvant to ropivacaine in supraclavicular brachial plexus block
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 10, Issue 1
Abstract
Background: Different adjuvants have been added to local anesthetic to augment the duration of supraclavicular brachial plexus block. This study was done to study the adjuvant effect of dexamethasone when added with 0.5% Ropivacaine in supraclavicular brachial plexus block. Objective: The objective of the study was to evaluate onset of sensory and motor blockade, duration of analgesia and motor blockade with dexamethasone as an adjuvant to ropivacaine in patients undergoing upper limb surgeries by supraclavicular brachial plexus block. Materials and Methods: After ethics committee approval this randomized, double-blinded, control study was conducted in the Department of Anaesthesiology, BKL Walawalkar Rural Medical College, Sawarde from July 2018 to November 2018. A total of 50 patients who met the inclusion criteria were enrolled into the study and were randomized to receive plain ropivacaine and ropivacine with dexamethasone. Group R (control group) patients (n = 22) received 35 ml of 0.5% ropivacaine with normal saline (2 ml) whereas Group RD (study group) patients (n = 23) received 35 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml). Five patients (three patients in group R and two patients in group RD) failed to achieve satisfactory levels of anaesthesia and required induction of general anaesthesia and were excluded from the study. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The duration of motor blockade was also noted in the post-operative period. The secondary outcome included visual analogue scale (VAS) hourly for first 6 hours and then two hourly till 24 hours, time of first analgesia (TFA), total rescue analgesia consumption, and side effects, if any. There was no statistically significant difference in the onset of sensory and motor blockade between both the groups. The mean duration of sensory blockade in group RD was 834±78.1min and in group R was found to be 276±38.73 min and was statistically significant (P ≤ 0.001).The mean duration of motor blockade in group RD was 376.4±39.99 min and in group R was 175.2±26.94 min and was statistically significant (P ≤ 0.001) .In Group R, patients required first rescue analgesia at 8 hour (480 ± 28.44 min) while in Group RD, patients required first rescue analgesia at 18hour 10min(1086.63±34.90min), which was found statistically significant (p< 0.0001). Group R patients received larger amount of Diclofenac as rescue analgesia(104.34 mg versus 81.81mg in Group RD) which was statistically significant (P 0.0099). Conclusion: We conclude that addition addition of dexamethasone to Ropivacaine in brachial plexus block significantly prolongs the duration of analgesia and motor block in patients undergoing upper limb surgeries and is a remarkably safe method of providing postoperative analgesia.
Authors and Affiliations
Shailendra Patil, Kashinath Jadhav, Vaishali Bapat, Rajesh Pawar
Keywords
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- EP ID EP589644
- DOI 10.26611/101510111
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