Effect of Dexamethasone as an Adjuvant to Bupivacaine for Ultrasound-guided Axillary Plexus Block: A Randomized, Double-blinded Prospective Study

Document Type : RESEARCH PAPER

Authors

1 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran

2 Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

3 Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

4 Zanjan University of Medical Science, Zanjan, Iran

10.22038/abjs.2024.72778.3389

Abstract

Objectives: The study evaluated sensory and motor block onset time, duration, and intensity, as well as pain intensity, sedation levels, and vital signs, showing that adding dexamethasone to bupivacaine improved sensory and motor block onset time, duration, and intensity, enhanced sedation effects. Axillary plexus block is a common type of anesthesia for surgical management of upper extremity injuries.
Methods: This prospective clinical trial included 72 patients over 18 years of age who were candidates for surgical management of upper extremity injuries with the axillary plexus block approach. The patients were randomly divided into two groups: group BD [30 ml bupivacaine 0.25% with 2ml dexamethasone (n=36)] and group B [30 ml bupivacaine 0.25% with 2ml distilled water (n=36)]. The Pinprick test and Modified Bromage Scale (MBS) were used to evaluate the sensory and motor block levels. Additionally, the Visual Analogue Scale (VAS) and Ramsay Sedation Scale (RSS) were used to assess pain intensity and degree of sedation. All collected data were analyzed using IBM SPSS Statistics version 20 software.
Results: The mean age of patients in the B and BD groups was 34.41±11.11 and 36.8±13.3, respectively. According to the results, there was a significant difference in the average time of sensory and motor block onset between two groups, with group BD showing shorter onset time compared to group B (P<0.001). Moreover, the mean duration and intensity of the sensory and motor block were significantly higher in group BD (P<0.05). Additionally, the degree of sedation changes after the block started were more pronounced in group BD. There was no statistically significant difference between the two groups regarding changes in pain intensity, heart rates (HR), mean arterial blood pressure (MABP), and complications (P>0.05).
Conclusion: Adding dexamethasone to bupivacaine as a safe adjuvant drug effectively prolongs the axillary plexus block time duration and reduces post-surgery pain. Furthermore, it accelerates the onset time of sensory and motor block.
        Level of evidence: II

Keywords

Main Subjects

References

  1. Tzatzairis T, Skarentzos K, Grammatikos C, et al. Ultrasound Applications in Pediatric Orthopedics. Arch Bone Jt Surg. 2024; 12(7):457-468. doi: 10.22038/ABJS.2024.59904.2950.
  2. Bajpai V, Patel TK, Dwivedi P, et al. Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials. Braz J Anesthesiol. 2023; 73(5):665-675. doi: 10.1016/j.bjane.2022.07.005.
  3. Mohamed KH, Abdelrahman KA, Elameer AN, Ali IH. Morphine as an adjuvant to local anesthetics in axillary brachial plexus block in forearm and hand surgery. Journal of Current Medical Research and Practice. 2019; 4(2):131-6. doi: 10.4103/JCMRP.JCMRP_35_19.
  4. Liu DX, Zhu ZQ. Ultrasound‐guided peripheral trunk block technique: A new approach gradually stepping onto the stage of clinical anesthesia. Ibrain. 2021; 7(3):211-226. doi: 10.1002/j.2769-2795.2021.tb00085.x.
  5. Fard AB, Jabalameli M, Khorrami AM, Ghaderi MT, Mohammadpour M, Gharanizadeh K. The effect of adding corticosteroid to the periarticular injection cocktail for pain control after total hip and total knee arthroplasty: a double-blinded randomized clinical trial. Arch Bone Jt Surg. 2022; 10(12):1049-1055. doi: 10.22038/ABJS.2022.50610.2509.
  6. Alfred VM, Srinivasan G, Zachariah M. Comparison of ultrasound with peripheral nerve stimulator-guided technique for supraclavicular block in upper limb surgeries: a randomized controlled trial. Anesth Essays Res. 2018; 12(1):50-54. doi: 10.4103/aer.AER_211_17.
  7. Li L, Zhao Y, Guo L, Lv X, Yu G. Ultrasound guidance enhances the efficiency of brachial plexus block and ameliorates the vascular injury compared with nerve stimulator guidance in hand surgery patients. J Invest Surg. 2020; 33(6):530-535. doi: 10.1080/08941939.2018.1539792.
  8. Rashmi H, Komala H. Effect of dexmedetomidine as an adjuvant to 0.75% ropivacaine in interscalene brachial plexus block using nerve stimulator: a prospective, randomized double-blind study. Anesth Essays Res. 2017; 11(1):134-139. doi: 10.4103/0259-1162.181431.
  9. Minaei R, Salehpour M, Kouhestani E, Ghasemi M. A Randomized Double-Blind Prospective Study Comparing the Efficacy of Subperiosteal and Periarticular Injections of a Local Anesthetic for Postoperative Pain Management after Total Knee Arthroplasty. Arch Bone Jt Surg. 2023; 11(11):704-710. doi: 10.22038/ABJS.2023.72484.3371.
  10. Aghdashi MM, Dehghan K, Shokohi S, Shafagh S. Unusually prolonged motor and sensory block following single injection ultrasound-guided infraclavicular block with bupivacaine and dexamethasone. Anesth Pain Med. 2013; 3(2):260-2. doi:

 

        10.5812/aapm.10583.

  1. Fahmy NG, Ahmed DM, Sameer GM. A comparative study between the addition of MgSO 4 against dexamethasone to bupivacaine in the prolongation of ultrasound-guided interscalene nerve block for shoulder arthroscopy. Ain Shams Journal of Anesthesiology. 2015; 8(3). doi:10.4103/1687-7934.161719.
  2. Lee MJ, Koo DJ, Choi YS, Lee KC, Kim HY. Dexamethasone or dexmedetomidine as local anesthetic adjuvants for ultrasound-guided axillary brachial plexus blocks with nerve stimulation. Korean J Pain. 2016; 29(1):29-33. doi: 10.3344/kjp.2016.29.1.29.
  3. McHardy PG, Singer O, Awad IT, et al. Comparison of the effects of perineural or intravenous dexamethasone on low volume interscalene brachial plexus block: a randomised equivalence trial. Br J Anaesth. 2020; 124(1):84-91. doi: 10.1016/j.bja.2019.08.025.
  4. Badran MA, Kamaly AM, Abdel Hamid HM, Mostafa RH. Dexamethasone as a bupivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a prospective randomized study. Ain-Shams Journal of Anesthesiology. 2020; 12(1).doi:10.1186/s42077-020-00113-7.
  5. Baeriswyl M, Kirkham K, Jacot-Guillarmod A, Albrecht E. Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2017; 119(2):183-191. doi: 10.1093/bja/aex191.
  6. Kirkham KR, Albrecht E. Perineural or intravenous dexamethasone in interscalene brachial plexus block. Br J Anaesth. 2020; 124(1):15-17. doi: 10.1016/j.bja.2019.09.010.
  7. Kore SS, Ubhe SB, Fasil F. Comparison between dexamethasone and fentanyl as an adjuvant to bupivacaine and lignocaine in supraclavicular brachial plexus block for upper limb surgery. Journal of Pharmacology and Pharmacotherapeutics. 2022; 13(1):59-65. doi:10.1177/0976500X221085803.
  8. Bromage P, Burfoot M, Crowell D, Pettigrew R. Quality of epidural blockade I: influence of physical factors. Br J Anaesth. 1964:36:342-52. doi: 10.1093/bja/36.6.342.
  9. Ramsay M, Savege T, Simpson B, Goodwin eR. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2(5920):656-9. doi: 10.1136/bmj.2.5920.656.
  10. Alavi CE, Asgari SA, Falahatkar S, et al. Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor. Turk J Urol. 2017 43(4):507-511. doi: 10.5152/tud.2017.96992.
  11. Sakae TM, Marchioro P, Schuelter-Trevisol F, Trevisol DJ. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a randomized, double-blinded clinical trial. J Clin Anesth. 2017:38:133-136. doi: 10.1016/j.jclinane.2017.02.004.
  12. Dalcortivo RL, Yarbrough BA, Congiusta DV, Ahmed IH, Vosbikian MM. Anesthesia Type and Short-Term Outcomes in Open Treatment of Hand Fractures. Arch Bone Jt Surg. 2024; 12(10):721-727. doi: 10.22038/ABJS.2024.67440.3200.
  13. Chazapi A, Lepetsos P, Gambopoulou Z, Siafaka I, Argyra E, Vadalouka A. Analgesic effect of the topical use of dexamethasone in ultrasound-guided axillary brachial plexus blockade: a prospective, randomized, double-blind, placebo-controlled study. Cureus. 2021; 13(1):e12971. doi: 10.7759/cureus.12971.
  14. Clement J-C, Besch G, Puyraveau M, et al. Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial. Reg Anesth Pain Med. 2019; 44(3):e100035. doi: 10.1136/rapm-2018-100035.
  15. Yaghoobi S, Seddighi M, Yazdi Z, Ghafouri R, Khezri MB. Comparison of postoperative analgesic effect of dexamethasone and fentanyl added to lidocaine through axillary block in forearm fracture. Pain Res Treat. 2013:2013:761583. doi: 10.1155/2013/761583.
  16. Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: a randomized controlled trial. Anesth Analg. 2015; 121(6):1655-60. doi: 10.1213/ANE.0000000000001006.
  17. Thomas S, Goodman EJ, Bravo-Fernandez C, Holbrook CR. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004; 29(4):380-1. doi: 10.1016/j.rapm.2004.03.006.
  18. Kim YJ, Lee GY, Kim DY, Kim CH, Baik H-J, Heo S. Dexamathasone added to levobupivacaine improves postoperative analgesia in ultrasound guided interscalene brachial plexus blockade for arthroscopic shoulder surgery. Korean J Anesthesiol. 2012; 62(2):130-4. doi: 10.4097/kjae.2012.62.2.130.
  19. ALE BM, Tabasi M, Emani F, ENTEZARI S. The Effect of Adding Dexamethasone to Sodium bicarbonate and Lidocaine 1.5% on the Onset and Duration of Axillary Block as well as Post Operative Analgesia in the Upper Extremity Procedures.2009.
  20. Moshari M, Hosseini B, Alshohadaei SM, Baghizadeh F. Comparison of Dexamethasone Composition with Bupivacaine and Dexmedetomidine with Bupivacaine and Bupivacaine alone in a Supraclavicular Block with Low Volume. Archives of Anesthesiology and Critical Care. 2021; 7(1):38-43. doi:10.18502/aacc.v7i1.5480.
  21. Collaborators DT, Collaborative WMR. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017:357:j1455. doi: 10.1136/bmj.j1455.
  22. Sehmbi H, Brull R, Ceballos K, et al. Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block. Anaesthesia. 2021; 76(7):974-990. doi: 10.1111/anae.15288.
  23. Polderman J, Farhang‐Razi V, Van Dieren S, et al. Adverse side‐effects of dexamethasone in surgical patients-an abridged Cochrane systematic review. Anaesthesia. 2019; 74(7):929-939. doi: 10.1111/anae.14610.

 

 

 

 

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 3
March 2025
Pages 138-145

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History

  • Receive Date: 19 July 2023
  • Revise Date: 27 January 2025
  • Accept Date: 06 November 2024

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