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  • Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial

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Original research
Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial
  1. Youngwon Kim1,
  2. Seokha Yoo2,
  3. Sae Hoon Kim3,
  4. Hansol Kim2,
  5. Jinyoung Bae4,
  6. Sun-Kyung Park5,
  7. Jin-Tae Kim2 and
  8. Young-Jin Lim2
  1. 1Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  2. 2Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  3. 3Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  4. 4Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
  5. 5Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Seokha Yoo, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; muroki85{at}snu.ac.kr

Abstract

Introduction This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery.

Methods Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit.

Results The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: −1.2 hours; 95% CI −3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001).

Conclusions Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery.

Trial registration number Clinical Research Information Service of Republic of Korea Registry (KCT0005998).

  • Nerve Block
  • Pain Management
  • Brachial Plexus
  • Upper Extremity
  • Acute Pain

Data availability statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/rapm-2023-104520

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    Data availability statement

    The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Presented at The results from this study were presented in the 16th Asian Australasian Congress of Anesthesiologists, Seoul, Korea on November 10–November 13, 2022.

    • Contributors YK contributed to data acquisition, data analysis, and manuscript preparation. SY contributed to the study conception and design, data analysis, and revision of the manuscript. SHK contributed to the data collection and revision of the manuscript. HK contributed to data analysis and manuscript preparation. JB contributed to data analysis and revision of the manuscript. S-KP contributed to data collection and revision of the manuscript. J-TK contributed to the study design, data collection, and revision of the manuscript. Y-JL contributed to the study design, data interpretation, and revision of the manuscript. All authors read and approved the final version of the manuscript. SY is responsible for the overall content as a 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; externally peer reviewed.