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Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial
  1. Jean-Christophe Clement1,
  2. Guillaume Besch1,2,
  3. Marc Puyraveau3,
  4. Tommy Grelet1,
  5. David Ferreira1,
  6. Lucie Vettoretti1,
  7. Sébastien Pili-Floury1,2,
  8. Emmanuel Samain1,2 and
  9. Francis Berthier1
  1. 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Bourgogne Franche-Comte University, Besancon, France
  2. 2 EA 3920, Bourgogne Franche-Comte University, Besancon, France
  3. 3 Clinical Methodology Center, University Hospital of Besancon, Bourgogne Franche-Comte University, Besancon, France
  1. Correspondence to Emmanuel Samain, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Bourgogne Franche-Comte University, Besancon F-25000, France; emmanuel.samain{at}univ-fcomte.fr

Abstract

Background and objectives The effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery.

Methods In this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications.

Results Among the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, p<0.0004). Motor and sensory recovery occurred significantly later, and total analgesic consumption was lower in the Dexa than in the Control group. No nerve complication related to intravenous dexamethasone injection was recorded.

Conclusions This study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block.

Trial registration number NCT02862327

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Footnotes

  • Presented at Interim data from this work were presented at the 2017 French Society of Anesthesiology and Intensive Care national meeting in Paris, September 21–23, 2017.

  • Funding The study was supported by Institutional funding from the University Hospital of Besancon, Besancon, France.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board Est-II, University Hospital of Besancon, France (#16/501, Chairperson Prof Toussirot, October 14, 2016), and by the French National Health Products Safety Agency (#1 51 520A-31, August 23, 2016).

  • Provenance and peer review Not commissioned; externally peer reviewed

  • Author note The work is attributed to the University Hospital of Besancon, Besancon, France.

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