Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial
Aparna Pande, Indu Mohini Sen, Aakriti Gupta, Ankur Gupta, Ashish Sharma
Abstract
Background and aims
Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB.
Methods
Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months.
Results
All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34).
Conclusion
Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.
Keywords
References
[1] S Choi, R Rodseth, CJ. 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
[2] E Albrecht, C Kern, KR Kirkham A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks Anesthesia, 70 (2015), pp. 71-83
[3] TM Huynh, E Marret, F. Bonnet Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: a meta-analysis of randomised controlled trials Eur J Anaesthesiol, 32 (2015), pp. 751-758
[4] A Gupta, A Gupta, N. Yadav Effect of dexamethasone as an adjuvant to ropivacaine on duration and quality of analgesia in ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section - A prospective, randomised, single-blinded study Indian J Anaesth, 63 (2019), pp. 469-474
[5] KR Kirkham, A Jacot-Guillarmod, E Albrecht Optimal dose of perineural dexamethasone to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis Anesth Analg, 126 (2018), pp. 270-279
[6] R Bartlett, AJ. Hartle Routine use of dexamethasone for postoperative nausea and vomiting: the case against Anesthesia, 68 (2013), pp. 892-896
[7] BA Williams, NJ Schott, MP Mangione, et al. Perineural dexamethasone and multimodal perineural analgesia: how much is too much? Anesth Analg, 18 (2014), pp. 912-914
[8] D Gaumann, A Forster, M Griessen, et al. Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block Anesth Analg, 75 (1992), pp. 69-74
[9] BM. Ilfeld Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel, alternative analgesic modalities Anesth Analg, 124 (2017), pp. 308-335
[10] C Wahal, A Kumar, S. Pyati Advances in regional anesthesia: A review of current practice, newer techniques and outcomes Indian J Anaesth, 62 (2018), pp. 94-102
[11] NS Bailard, J Ortiz, RA Flores Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations Am J Health Syst Pharm, 71 (2014), pp. 373-385
[22] A Swain, DS Nag, S Sahu, et al. Adjuvants to local anesthetics: Current understanding and future trends World J Clin Cases, 5 (2017), pp. 307-323
[13] A Bhatia, D Flamer, PS Shah Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis Can J Anaesth, 62 (2015), pp. 650-662
[12] R Marks, JW Barlow, JW. Funder Steroid-induced vasoconstriction: Glucocorticoid antagonist studies J Clinical Endocrinol Metabol, 54 (1982), pp. 1075-1077
[15] A Johansson, J Hao, B. Sjolund Local corticosteroid application blocks transmission in normal nociceptive C-fibres Acta Anaesthesiol Scand, 34 (1990), pp. 335-338
[14] PA Biradar, G Kannappady, K. Padmanabha Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomized, double-blind study Indian J Anaesth, 57 (2013), pp. 180-184
[17] J Liu, KA Richman, SR Grodofsky, et al. Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study J Clinical Anesth, 27 (2015), pp. 237-242
[16] JH Woo, YJ Kim, DY 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
[19] E Albrecht, M Reynvoet, N Fournier, et al. Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple-blind trial Anesthesia, 74 (2019), pp. 1001-1008
[18] D Bravo, J Aliste, S Layera, et al. A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block Reg Anesth Pain Med, 44 (2019), pp. 46-51
[21] FW Abdallah, SH Halpern, K Aoyama, et al. Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis Anesth Analg, 120 (2015), pp. 1114-1129
[20] JT Farrar, RK Portenoy, JA Berlin, et al. Defining the clinically important difference in pain outcome measures Pain, 88 (2000), pp. 287-294
[23] DG McGrogan, AP Maxwell, AZ Khawaja, et al. Current tools for prediction of arteriovenous fistula outcomes Clin Kidney J, 8 (2015), pp. 278-281
[24] CJ Renaud, CR Leong, HW Bin, et al. Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes J Vasc Surg, 62 (2015), p. 1266 -12
[25] C Gao, C Weng, C He, et al. Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis BMC Anesthesiol, 20 (2020), p. e219
[26] A Ismail, AI Abushouk, AH Bekhet, et al. Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis J Vasc Access, 18 (2017), pp. 177-184
[27] DG McGrogan, AP Maxwell, AZ Khawaja, et al. Current tools for prediction of arteriovenous fistula outcomes Clin Kidney J, 8 (2015), pp. 278-281
[28] ZM Khavanin, S Mohammadipour, Z Omrani Correlation between CRP and early failure of arteriovenous fistula Med J Islam Repub Iran, 29 (2015), pp. 219-223
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