Efficacy Of Systemic Or Perineural Dexamethasone As An Adjunct To Ultrasound Guided Supraclavicular Block

Abstract

Background: Regional anaesthesia (RA) techniques have traditionally been utilized for surgical anaesthesia and post-operative pain control. Post-operative analgesia from an epidural or a peripheral nerve block can benefit the patients with better recovery and more satisfaction. Innumerable additives have been tried in nerve blocks with variable results. We wished to evaluate the use of addition of dexamethasone with local anaesthetics and compare the efficacy with simultaneous administration of systemic dexamethasone in brachial plexus blocks. Methods: Ninety-seven patients posted for upper limb surgeries were divided randomly into three groups to receive ultrasound guided supraclavicular brachial plexus block with bupivacaine saline combination(A) or dexamethasone bupivacaine combination(B) or a systemic dexamethasone(C) with bupivacaine alone in the plexus site. The onset and duration of sensory and motor blocks were noted.ANOVA, Chi square tests and intent to analyses were done according to the need and a p value of less than 0.05 was considered significant. Results: The variables like mean age, weight, duration of surgery were similar between the groups. The onset and duration of sensory and motor blocks were similar with addition of dexamethasone either in plexus(perineural) or systemic. Onset (A, B, C -17 vs 12 vs 12 in minutes) duration of sensory anaesthesia (414 vs 857 vs 838 minutes) But patients in both the dexamethasone groups showed significant shortening of action in onset and prolonged duration than saline group. (p <0.001), There were no significant side effects.Conclusion: Systemic dexamethasone had a similar effect on the onset and duration of both the sensory and motor actions in supraclavicular brachial plexus blocks as perineural dexamethasone. Dexamethasone usage, both systemic and perineural, reduces cumulative postoperative analgesic usage in the first 24 hours. Either of the two techniques outperformed the control group, which received only normal saline. There were no significant negative side effects.