Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

To identify the effects of adding two different doses of dexamethasone on the duration and quality of interscalene block in patients undergoing shoulder surgery in ambulatory surgery settings.

Methods

The study design was reviewed and approved by the University at Buffalo Institutional Review Board for Human Subjects. After obtaining informed consent, a total of 90 patients undergoing shoulder surgery using interscalene block with 0.5% bupivacaine (40 mL) were assigned randomly to one of three groups: control patients, “Group C,” who received no additive; low dose, “Group L,” who received additional dexamethasone 4 mg; and high dose, “Group H,” who received dexamethasone 8 mg in addition to 0.5% bupivacaine. Postoperative analgesia was assessed using the numeric rating scores of pain and the postoperative consumption of acetaminophen 325 mg + hydrocodone 7.5 mg tablets. Analysis was by intention to treat. Statistical significance was tested using a two-way analysis of variance and a nonparametric analysis of variance for consumption of analgesics.

Results

Four patients were excluded from the study due to either a failed block or inadequate follow-up. The duration of analgesia was significantly prolonged in both Group L (21.6 ± 2.4 h) and Group H (25.2 ± 1.9 h) compared with Group C (13.3 ± 1.0 h) (p < 0.05). Similarly, the duration of motor block was longer in both Group L (36.7 ± 4.1 h), and Group H (39.2 ± 3.9 h) compared to Group C (24.6 ± 3.3 h) (p < 0.05). Postoperative analgesic consumption for the first 48 h was significantly lower in Group L (6.5 [4–8] tabs) and in Group H (5.5 [4–7] tabs) vs. 9.5 [8–12] tabs in Group C (p < 0.01). There were no adverse events related to dexamethasone during the 4-week follow-up period.

Conclusion

The addition of dexamethasone to bupivacaine significantly prolonged the duration of the motor block and improved the quality of analgesia following interscalene block. There was no difference in the duration of analgesia and motor block between low-dose and high-dose dexamethasone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9:295–300.

    Article  PubMed  CAS  Google Scholar 

  2. Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg. 1995;81:321–8.

    PubMed  CAS  Google Scholar 

  3. Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B. Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med. 2003;28:29–32.

    PubMed  CAS  Google Scholar 

  4. Grossi P, Allegri M. Continuous peripheral nerve blocks: state of the art. Curr Opin Anaesthesiol. 2005;18:522–6.

    Article  PubMed  Google Scholar 

  5. Litz RJ, Vicent O, Wiessner D, Heller AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med. 2004;29:60–4.

    PubMed  Google Scholar 

  6. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109:502–11.

    Article  PubMed  CAS  Google Scholar 

  7. Hoffmann V, Schimrigk S, Islamova S, Hellwig K, Lukas C, Brune N, Pöhlau D, Przuntek H, Müller T. Efficacy and safety of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients. J Neurol Sci. 2003;211:81–4.

    Article  PubMed  CAS  Google Scholar 

  8. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–7.

    Article  PubMed  CAS  Google Scholar 

  9. Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular brachial plexus block with and without dexamethasone—a comparative study. Kathmandu Univ Med J. 2003;1:158–60.

    CAS  Google Scholar 

  10. Shrestha BR, Maharjan SK, Thapa C. Comparative study between bupivacaine heavy vs. pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section. Kathmandu Univ Med J. 2007;5:166–72.

    CAS  Google Scholar 

  11. Banaszkiewicz PA, Kader D, Wardlaw D. The role of caudal epidural injections in the management of low back pain. Bull Hosp Jt Dis. 2003;61:127–31.

    PubMed  Google Scholar 

  12. Bansal S, Turtle MJ. Inadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent. Anaesth Intensive Care. 2003;31:570–2.

    PubMed  CAS  Google Scholar 

  13. Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief update and review of the medical literature. J Bone Joint Surg Am. 2006;88:1361–72.

    Article  PubMed  Google Scholar 

  14. Stan T, Goodman EJ, Bravo-Fernandez C, Holbrook CR. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004;29:380–1.

    PubMed  CAS  Google Scholar 

  15. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990;34:335–8.

    Article  PubMed  CAS  Google Scholar 

  16. Copur MS, Ledakis P, Norvell M. Prevention of delayed emesis caused by chemotherapy. N Engl J Med. 2000;343:888–9.

    Article  PubMed  CAS  Google Scholar 

  17. Werner MU, Lassen B, Kehlet H. Analgesic effects of dexamethasone in burn injury. Reg Anesth Pain Med. 2002;27:254–60.

    PubMed  CAS  Google Scholar 

  18. Kohane DS, Smith SE, Louis DN, Colombo G, Ghoroghchian P, Hunfeld NGM, Berde CB, Langer RS. Prolonged duration local anesthesia from tetrodotoxin-enhanced local anesthetic microspheres. Pain. 2003;104:415–21.

    Article  PubMed  CAS  Google Scholar 

  19. Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostal blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003;96:576–82.

    PubMed  CAS  Google Scholar 

  20. Goodman E, Stan T. Potentially concerning reason why adding methylprednisolone to local anesthetic may increase the duration of axillary block. Reg Anesth Pain Med. 2005;30:114–5.

    Google Scholar 

  21. Shishido H, Kikuchi S, Heckman H, Myers RR. Dexamethasone decreases blood flow in normal nerves and dorsal root ganglia. Spine. 2002;27:581–6.

    Article  PubMed  Google Scholar 

  22. Stahl S, Kaufman T. Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis. J Hand Surg. 1997;22:69–70.

    CAS  Google Scholar 

  23. Mackinnon SE, Hudson AR, Gentili F, Kline DG, Hunter D. Peripheral nerve injection injury with steroid agents. Plast Reconstr Surg. 1982;69:482–90.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The funding for this study was provided by Buffalo Anesthesiology Associates PC.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, SUNY-Buffalo, Buffalo, USA

    Merle N. Tandoc, Liang Fan, Sergei Kolesnikov, Alexander Kruglov & Nader D. Nader

  2. Department of Anesthesiology and Perioperative Care, VA Western NY Healthcare System, 3495 Bailey Ave, Rm 202C, Buffalo, NY, 14215, USA

    Nader D. Nader

Authors
  1. Merle N. Tandoc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liang Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergei Kolesnikov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Kruglov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nader D. Nader
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nader D. Nader.

About this article

Cite this article

Tandoc, M.N., Fan, L., Kolesnikov, S. et al. Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial. J Anesth 25, 704–709 (2011). https://doi.org/10.1007/s00540-011-1180-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-011-1180-x

Keywords

Search

Navigation