Abstract
Purpose
To identify the effects of adding two different doses of dexamethasone on the duration and quality of interscalene block in patients undergoing shoulder surgery in ambulatory surgery settings.
Methods
The study design was reviewed and approved by the University at Buffalo Institutional Review Board for Human Subjects. After obtaining informed consent, a total of 90 patients undergoing shoulder surgery using interscalene block with 0.5% bupivacaine (40 mL) were assigned randomly to one of three groups: control patients, “Group C,” who received no additive; low dose, “Group L,” who received additional dexamethasone 4 mg; and high dose, “Group H,” who received dexamethasone 8 mg in addition to 0.5% bupivacaine. Postoperative analgesia was assessed using the numeric rating scores of pain and the postoperative consumption of acetaminophen 325 mg + hydrocodone 7.5 mg tablets. Analysis was by intention to treat. Statistical significance was tested using a two-way analysis of variance and a nonparametric analysis of variance for consumption of analgesics.
Results
Four patients were excluded from the study due to either a failed block or inadequate follow-up. The duration of analgesia was significantly prolonged in both Group L (21.6 ± 2.4 h) and Group H (25.2 ± 1.9 h) compared with Group C (13.3 ± 1.0 h) (p < 0.05). Similarly, the duration of motor block was longer in both Group L (36.7 ± 4.1 h), and Group H (39.2 ± 3.9 h) compared to Group C (24.6 ± 3.3 h) (p < 0.05). Postoperative analgesic consumption for the first 48 h was significantly lower in Group L (6.5 [4–8] tabs) and in Group H (5.5 [4–7] tabs) vs. 9.5 [8–12] tabs in Group C (p < 0.01). There were no adverse events related to dexamethasone during the 4-week follow-up period.
Conclusion
The addition of dexamethasone to bupivacaine significantly prolonged the duration of the motor block and improved the quality of analgesia following interscalene block. There was no difference in the duration of analgesia and motor block between low-dose and high-dose dexamethasone.
Similar content being viewed by others
References
Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9:295–300.
Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg. 1995;81:321–8.
Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B. Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med. 2003;28:29–32.
Grossi P, Allegri M. Continuous peripheral nerve blocks: state of the art. Curr Opin Anaesthesiol. 2005;18:522–6.
Litz RJ, Vicent O, Wiessner D, Heller AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med. 2004;29:60–4.
Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109:502–11.
Hoffmann V, Schimrigk S, Islamova S, Hellwig K, Lukas C, Brune N, Pöhlau D, Przuntek H, Müller T. Efficacy and safety of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients. J Neurol Sci. 2003;211:81–4.
Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–7.
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.
Shrestha BR, Maharjan SK, Thapa C. Comparative study between bupivacaine heavy vs. pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section. Kathmandu Univ Med J. 2007;5:166–72.
Banaszkiewicz PA, Kader D, Wardlaw D. The role of caudal epidural injections in the management of low back pain. Bull Hosp Jt Dis. 2003;61:127–31.
Bansal S, Turtle MJ. Inadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent. Anaesth Intensive Care. 2003;31:570–2.
Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief update and review of the medical literature. J Bone Joint Surg Am. 2006;88:1361–72.
Stan T, Goodman EJ, Bravo-Fernandez C, Holbrook CR. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004;29:380–1.
Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990;34:335–8.
Copur MS, Ledakis P, Norvell M. Prevention of delayed emesis caused by chemotherapy. N Engl J Med. 2000;343:888–9.
Werner MU, Lassen B, Kehlet H. Analgesic effects of dexamethasone in burn injury. Reg Anesth Pain Med. 2002;27:254–60.
Kohane DS, Smith SE, Louis DN, Colombo G, Ghoroghchian P, Hunfeld NGM, Berde CB, Langer RS. Prolonged duration local anesthesia from tetrodotoxin-enhanced local anesthetic microspheres. Pain. 2003;104:415–21.
Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostal blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003;96:576–82.
Goodman E, Stan T. Potentially concerning reason why adding methylprednisolone to local anesthetic may increase the duration of axillary block. Reg Anesth Pain Med. 2005;30:114–5.
Shishido H, Kikuchi S, Heckman H, Myers RR. Dexamethasone decreases blood flow in normal nerves and dorsal root ganglia. Spine. 2002;27:581–6.
Stahl S, Kaufman T. Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis. J Hand Surg. 1997;22:69–70.
Mackinnon SE, Hudson AR, Gentili F, Kline DG, Hunter D. Peripheral nerve injection injury with steroid agents. Plast Reconstr Surg. 1982;69:482–90.
Acknowledgments
The funding for this study was provided by Buffalo Anesthesiology Associates PC.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Tandoc, M.N., Fan, L., Kolesnikov, S. et al. Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial. J Anesth 25, 704–709 (2011). https://doi.org/10.1007/s00540-011-1180-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-011-1180-x