Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.10.012
Brazilian Journal of Anesthesiology
Original Investigation

Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Baixa dose perineural de dexametasona como adjuvante no bloqueio supraclavicular do plexo braquial para criação de fístula arteriovenosa em doença renal terminal: um ensaio clínico randomizado

Aparna Pande, Indu Mohini Sen, Aakriti Gupta, Ankur Gupta, Ashish Sharma

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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 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

Arteriovenous fistula;  Brachial plexus block;  Dexamethasone;  Anesthetics, local

Resumo

Introdução

A dexametasona como adjuvante da solução anestésica local melhora a qualidade do bloqueio do plexo braquial (BPB). No entanto, faltam evidências de sua eficácia em doses baixas (< 4 mg). Este estudo foi desenhado para avaliar a duração da analgesia obtida com dexametasona em baixas doses como adjuvante do anestésico local para criação de fístula arteriovenosa (FAV) sob BPB.

Métodos

Sessenta e seis pacientes programados para criação de FAV foram alocados aleatoriamente para receber solução salina (controle) ou 2 mg de dexametasona, juntamente com ropivacaína a 0,5% e lidocaína a 0,2%. O desfecho primário foi a duração da analgesia, definida como o tempo desde a realização do bloqueio até a primeira solicitação de analgésico. Os desfechos secundários foram o tempo desde a injeção até o bloqueio sensitivo completo, o tempo desde a injeção até o bloqueio motor completo, a duração do bloqueio motor, o consumo de analgésico no pós-operatório e a desobstrução da fístula em três meses.

Resultados

Todos os bloqueios foram eficazes. No grupo que recebeu dexametasona, o tempo até a primeira solicitação de analgésico foi significativamente retardado (432 ± 43,8 minutos vs. 386,4 ± 40,2 minutos; p < 0,01). O início do bloqueio sensorial e motor ocorreu mais rapidamente no grupo dexametasona e o consumo global de analgésicos também foi reduzido. Contudo, a adição de dexametasona não prolongou a duração do bloqueio motor. Não houve diferença estatisticamente significativa na patência das fístulas entre os dois grupos aos três meses. (p = 0,34).

Conclusão

A adição de dexametasona perineural em baixas doses à solução anestésica local prolongou significativamente a duração da analgesia. Mais ensaios são necessários para comparar os efeitos adversos entre doses de dexametasona de 4 mg e inferiores.

Palavras-chave

Fístula arteriovenosa; Bloqueio do plexo braquial; Dexametasona; Anestésicos locais

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