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Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block
  1. Julián Aliste1,
  2. Sebastián Layera1,
  3. Daniela Bravo1,
  4. Germán Aguilera1,
  5. Hans Erpel1,
  6. Armando García2,
  7. Marcelo Lizama2,
  8. Roderick J Finlayson3 and
  9. De Q Tran4
  1. 1Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
  2. 2Department of Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
  3. 3Bill Nelems Pain and Research Center, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
  4. 4Department of Anesthesia, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Daniela Bravo, Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile 8380456, Chile; danibravoadvis{at}gmail.com

Abstract

Background This randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block.

Methods Fifty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (2 mg) or combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg). After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), the onset time (defined as the time required to reach a minimal composite score of 14 points) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids or general anesthesia).

Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block and postoperative analgesia.

Results No intergroup differences were observed in terms of success rate, onset time and surgical anesthesia. Compared with dexamethasone alone, combined dexamethasone-dexmedetomidine provided longer durations of motor block (21.5 (2.7) vs 17.0 (3.9) hours; p<0.001; 95% CI 2.6 to 6.4), sensory block (21.6 (3.6) vs 17.2 (3.6) hours; p<0.001; 95% CI 2.2 to 6.5), and postoperative analgesia (25.5 (9.4) vs 23.5 (5.6) hours; p=0.038; 95% CI 1.0 to 7.7).

Conclusion Compared with perineural dexamethasone (2 mg) alone, combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg) results in longer durations of sensorimotor block and analgesia. Further studies are required to determine the optimal dosing combination for dexamethasone-dexmedetomidine.

Trial registration number ClinicalTrials.gov identifier: NCT04875039.

  • brachial plexus
  • acute pain
  • pain, postoperative
  • nerve block

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @AlisteJulian, @s_layera, @danibrava, @GerAguileraC, @erpel_hans

  • Contributors JA, SL, DB, GA, HE, AG, and ML participated in the planning, conduct, reporting, conception and design, acquisition of data, data analysis, and interpretation of data. RJF and DQHT participated in the planning, conception, design, data analysis, and interpretation of data. DB is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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