Safety and Duration of Low-Dose Adjuvant Dexamethasone in Regional Anesthesia for Upper Extremity Surgery: A Prospective, Randomized, Controlled Blinded Study.

Autor:	Gouda N; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA., Zangrilli J; Rowan School of Osteopathic Medicine, Stratford, NJ, USA., Voskerijian A; Jefferson Surgery Center at the Navy Yard, Philadelphia, PA, USA.; United Anesthesia Services, P.C., Bryn Mawr, PA, USA., Wang ML; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA., Beredjiklian PK; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA., Rivlin M; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Jazyk:	angličtina
Zdroj:	Hand (New York, N.Y.) [Hand (N Y)] 2022 Nov; Vol. 17 (6), pp. 1236-1241. Date of Electronic Publication: 2021 Apr 21.
DOI:	10.1177/15589447211008558
Abstrakt:	Background: Orthopedic procedures concerning the upper extremity commonly use a brachial plexus nerve block to achieve postoperative analgesia. The addition of dexamethasone to peripheral nerve blocks has been shown to significantly prolong its effect. We hypothesize that 1 mg doses of dexamethasone will prolong brachial plexus nerve block with similar efficacy to 4 mg and better than ropivacaine alone. Methods: Seventy-nine patients who received a brachial plexus nerve block prior to undergoing upper extremity surgery were randomized to 1 of 4 treatment groups: group 1 received only 30 mL of 0.5% ropivacaine without dexamethasone (control); groups 2, 3, and 4 received 4, 2, and 1 mg of dexamethasone, respectively, added to 30 mL of 0.5% ropivacaine. Results: Comparison of block duration, specifically "first signs of the block wearing off" to the 0-mg group, referencing the 1-, 2-, and 4-mg groups ( P = .02, .04, and .01, respectively) that received steroid adjuvant therapy demonstrated a significant increase in time until the block began to wear off. All study groups receiving steroids also demonstrated a significant increase in duration of the block prior to its effects being completely gone when compared with the control group ( P < .01 for all groups). Conclusions: Our findings demonstrate that adjuvant dexamethasone can prolong brachial plexus nerve blocks effectively at low doses compared with high doses, in addition to prolonging analgesia compared with local anesthetic alone.
Databáze:	MEDLINE
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