Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.10.001
Brazilian Journal of Anesthesiology
Clinical Research

Perineural dexamethasone in ultrasound-guided interscalene brachial plexus block with levobupivacaine for shoulder arthroscopic surgery in the outpatient setting: randomized controlled trial

Dexametasona perineural em bloqueio de plexo braquial interescalênico com levobupivacaína guiado por ultrassonografia para artroscopia de ombro em regime ambulatorial: ensaio clínico controlado e randomizado

Mateus Meira Vasconcelos, João Paulo Jordão Pontes, Alexandre de Menezes Rodrigues, Demócrito Ribeiro de Brito Neto, Rodrigo Rodrigues Alves, Fernando Cássio do Prado Silva, Denis Fabiano de Souza

Downloads: 0
Views: 14

Abstract

Background and objectives
In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting.

Methods
After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D – blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C – 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS).

Results
Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant.

Conclusion
Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

Keywords

Dexamethasone,  Brachial plexus block,  Ultrasonography,  Anesthesia,  conduction,  Arthroscopy

Resumo

Justificativa e objetivos
Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial.

Métodos
Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D – bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C – bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA).

Resultados
Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p < 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72 vs. 0,02 ± 0,17; p < 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4% vs. 0%; p < 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante.

Conclusão
A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.

Palavras-chave

Dexametasona,  Bloqueio de plexo braquial,  Ultrassonografia,  Anestesia por condução,  Artroscopi

References

[1] M. Hughes, M. Matava, R. Wright, et al. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review J Bone Joint Surg Am., 95 (2013), pp. 1318-1324

[2] M. Desmet, H. Braems, M. Reynvoet, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study Br J Anaesth., 111 (2013), pp. 445-452

[3] R. Kawanishi, K. Yamamoto, Y. Tobetto, et al. Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial Local Reg Anesth., 7 (2014), pp. 5-9

[4] S. Choi, R. Rodseth, C. McCartney Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials Br J Anaesth., 112 (2014), pp. 427-439

[5] E. Albrecht, C. Kern, K. Kirkham A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks Anaesthesia., 70 (2015), pp. 71-83

[6] G. De Oliveira, L. Castro Alves, A. Nader, et al. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials Pain Res Treat., 2014 (2014), p. 179029

[7] M. Tandoc, L. Fan, S. Kolesnikov, et al. Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial J Anesth., 25 (2011), pp. 704-709

[8] J. Song, H. Shim, T. Lee, et al. Comparison of dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in brachial plexus block Korean J Anesthesiol., 66 (2014), pp. 283-289

[9] G. El-Baradey, N. Elshmaa The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block Saudi J Anaesth., 8 (Suppl 1) (2014), pp. S78-S83

[10] V. Nagpal, S. Rana, J. Singh, et al. Comparative study of systemically and perineurally administered tramadol as an adjunct for supraclavicular brachial plexus block J Anaesthesiol Clin Pharmacol., 31 (2015), pp. 191-195

[11] A. Senel, O. Ukinc, A. Timurkaynak Does the addition of tramadol and ketamine to ropivacaine prolong the axillary brachial plexus block? Biomed Res Int., 2014 (2014), p. 686287

[12] M. Lashgarinia, K. Naghibi, A. Honarmand, et al. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double- blind randomized clinical trial study Adv Biomed Res., 3 (2014), p. 232

[13] Q. Ali, L. Manjunatha, S. Amir, et al. Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study Indian J Anaesth., 58 (2014), pp. 709-713

[14] K. Gupta, V. Tiwari, P. Gupta, et al. Clonidine as an adjuvant for ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet: A clinical study J Anaesthesiol Clin Pharmacol., 30 (2014), pp. 533-537

[15] N. Knezevic, U. Anantamongkol, K. Candido Perineural dexamethasone added to local anesthesia for brachial plexus block improves pain but delays block onset and motor blockade recovery Pain Physician., 18 (2015), pp. 1-14

[16] S. Kumar, U. Palaria, A. Sinha, et al. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia Anesth Essays Res., 8 (2014), pp. 202-208

[17] F. Abdallah, J. Johnson, V. Chan, et al. Intravenous dexamethasone and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block: a randomized, triple-arm, double-blind, placebo-controlled trial Reg Anesth Pain Med., 40 (2015), pp. 125-132

[18] A. Jadon, S. Dixit, S. Kedia, et al. Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone Indian J Anaesth., 59 (2015), pp. 171-176

[19] E. Chun, Y. Kim, J. Woo Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery?. intravenous dexamethasone 5 mg vs. perineural dexamethasone 5 mg randomized, controlled, clinical trial Medicine (Baltimore)., 95 (2016), p. e3828

[20] Cummings Kr, D. Napierkowski, I. Parra-Sanchez, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine Br J Anaesth., 107 (2011), pp. 446-453

[21] D. Holland, R. Amadeo, S. Wolfe, et al. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial Can J Anaesth., 65 (2018), pp. 34-45

[22] T. Sakae, P. Marchioro, F. Schuelter-Trevisol, et al. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial J Clin Anesth., 38 (2017), pp. 133-136

[23] J. Woo, Y. Kim, D. Kim, et al. Dose-dependency of dexamethasone on the analgesic effect of interscalene block for arthroscopic shoulder surgery using ropivacaine 0.5%: A randomised controlled trial Eur J Anaesthesiol., 32 (2015), pp. 650-655

[24] F. Chalifoux, F. Colin, P. St-Pierre, et al. Low dose intravenous dexamethasone (4 mg and 10 mg) significantly prolongs the analgesic duration of single-shot interscalene block after arthroscopic shoulder surgery: a prospective randomized placebo-controlled study Can J Anaesth., 64 (2017), pp. 280-289

[25] D.M. Shah, M. Arora, A. Trikha, et al. Comparison of dexamethasone and clonidine as an adjuvant to 1,5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries J Anaesthesiol Clin Pharmacol., 31 (2015), pp. 354-359

5f931de70e88258b0c485d90 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections