The effects of application of 0.5% levobupivacaine together with 5 mg dexamethasone for infra-clavicular block in surgical treatment of forearm fractures

Ertugrul Kilic,Burcin Karsli,Murat Erkek,Ayse Mizrak,Mehmet Kursat Evrenos

doi:10.17546/msd.347650

Ertugrul Kilic, Burcin Karsli + Show 3 more

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https://doi.org/10.17546/msd.347650

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Abstract

Objective: We aimed to investigate the effects of adding 5mg dexamethasone to 0.5% levobupivacaine on postoperative analgesia after US-guided infra-clavicular block. Methods: This prospective study was performed at Sehitkamil Goverment Hospital, Gaziantep, Turkey, between september 2012 and february 2013. Ninty patients presented with fracture of forearm bones. Patients were randomly allocated to receive ultrasound guided infraclavicular brachial plexus blockade using levobupivacaine 0.5% in conjunction with or without dexamethasone 5 mg. In Group I (n=45), 0.9% NaCl was added as adjuvant. In Group II (n=45), 5 mg dexamethasone was added to 0.5% levobupivacaine and surgical anesthesia was provided. Postoperative pain control was provided by using morphine with intravenous patient controlled analgesia (IVPCA). one mg bolus dose was administered, continued with limit of 5 mg/hour and 10 min of locking time. Verbal ranting scala (VRS), patient satisfaction score (PSS) and total morphine consumption were controlled for postoperative 48 hours. Results: Sensory block onset time was significatly longer in group I. Sensory block time was longer in group II. PSS was higher in group II, total morphine consumption was found more in group I, VRS was significantly higher in group I. Conclusion: Application of 0.5% levobupivacaine together with 5 mg dexamethasone for infra-clavicular block in surgical treatment of forearm fractures reduces sensory block initiation time, prolongs duration of Sensorial Block and reduces analgesic consumption.

Highlights

Infra-clavicular brachial plexus block (IBPB) is one of the most preferred nerve block techniques among regional anesthesia techniques for hand, wrist, forearm and distal humerus surgery and/or for post-operative pain control in the same regions [1]
Our study revealed that use of 0.5% levobupivacaine and 5 mg dexamethasone mixture shortened sensory and motor block initial times, prolonged duration of both blocks and prolonged post-operative analgesia time in infra-clavicular block procedure done under US guidance in anesthesia in forearm fracture operations
In meta-analysis of Huynh et al, they reported that dexamethasone use prolonged motor and sensory block times in upper and lower peripheral nerve blocks, and block initiation time shortened in the blocks done using 10 mg dexamethasone

Summary

Introduction

Infra-clavicular brachial plexus block (IBPB) is one of the most preferred nerve block techniques among regional anesthesia techniques for hand, wrist, forearm and distal humerus surgery and/or for post-operative pain control in the same regions [1]. Some adjuvant drugs were used for prolonging regional block time. Epinephrin reduces systemic absorption of the drug through vasoconstriction and thereby prolongs duration of action. It shows analgesic effect through alpha-2 adrenergic pathway [6]. Addition of clonidine to LA drugs with moderate duration of action prolongs anesthetic and postanesthetic analgesia time through pre-synaptic and post-synaptic effect with alpha-1 and alpha-2 agonistic effect [7,8]. Dexamethasone, a long-acting glucocorticoid (t1/2 >36 h) has potent antiinflammatory and analgesic effects [9]

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