Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial
Eficácia da dexametasona ou clonidina como adjuvantes no bloqueio do plexo braquial interescalênico para prevenção da dor de rebote após cirurgia de ombro: um ensaio clínico randomizado
Layana Vieira Nobre; Leonardo Henrique Cunha Ferraro; Juscelino Afonso de Oliveira Junior; Vitoria Luiza Locatelli Winkeler; Luis Flavio França Vinhosa Muniz; Hiago Parreão Braga; Plínio da Cunha Leal
Abstract
Background
Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant’s addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain.
Methods
This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure.
Results
The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain.
Conclusions
The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.
Keywords
Resumo
Introdução
Acredita-se que a dor de rebote envolva tanto dor nociceptiva devido à analgesia insuficiente quanto hiperalgesia induzida por anestesia regional. A adição de adjuvante pode prevenir a dor de rebote. Este estudo teve como objetivo determinar se a adição de dexametasona ou clonidina ao anestésico local ao realizar o bloqueio interescalênico pode prevenir a dor de rebote.
Métodos
Este foi um ensaio clínico multicêntrico, prospectivo, de agrupamento paralelo, randomizado, conduzido com pacientes que receberam uma única injeção de bupivacaína 0,375% em bloqueio interescalênico guiado por ultrassom e anestesia geral para cirurgia de ombro e foram aleatoriamente designados para nenhum aditivo (controle), clonidina (30 mcg) ou dexametasona (4 mg). O desfecho primário foi dor de rebote, definida como início súbito de dor, intensidade moderada a grave (VAS ≥7) sem melhora com medicação oral, seguida por dor VAS em repouso, analgesia de resgate necessária, ocorrência de eventos adversos ou complicações e avaliações de pesquisa de satisfação entre os grupos. Dor de rebote e dor em repouso foram avaliadas 2, 4, 6, 12, 24 e 48 horas após o procedimento.
Resultados
A incidência de dor de rebote não foi estatisticamente diferente entre os grupos (valor de p = 0,22), com uma incidência observada de 41,2% (IC de 95% 25,9‒57,9), 28,6% (IC de 95% 16,7‒43,3) e 23,3% (IC de 95% 12,6‒37,6) nos grupos controle, dexametasona e clonidina, respectivamente. Além disso, não houve diferenças significativas entre os grupos no tempo, do bloqueio anestésico à primeira queixa de dor ou à gravidade da dor pós-operatória.
Conclusão
A administração de dexametasona ou clonidina como adjuvantes perineurais à anestesia local em bloqueios interescalênicos de injeção única não reduziu significativamente a incidência de dor de rebote.
Palavras-chave
References
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Submitted date:
07/02/2024
Accepted date:
11/09/2024
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