Title: A Comparative Evaluation of 0.5% Levobupivacaine in Combination with Dexamethasone and 0.5% Levobupivacaine alone in Nerve Stimulator Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective Randomized Single Blind Controlled Study

Authors: A.P. Agrawal, Amit kumar Rai, Rampal Singh, Malti Agrawal, Gopal Krishan, Akash Gupta, Ankur Garg

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.02

Abstract

Introduction: Brachial plexus block is a safe and well accepted technique of anaesthesia since it avoids the untoward side effects associated with general anaesthesia, resulting in more favorable outcome along with increased margin of safety. The aim of this study is to establish the role of dexamethasone as adjuvant to levobupivacaine in supraclavicular brachial plexus block.

Material and Method: A randomized single blind controlled study was done on 60 patients of ASA Grade I or II undergoing upper limb surgery. Group A received 30ml of 0.5% Levobupivacaine with 2 ml (8mg) Dexamethasone and group B received 30ml of 0.5% Levobupivacaine with 2 ml of 0.9% normal saline. Onset and duration of both sensory and motor blockade were studied in both the groups.

Results: It was observed that in group A, onset of sensory and motor blockade was faster than group B. Group A had longer duration of sensory and motor blockade in comparison of group B.

Conclusion: It was concluded that the addition of 8mg of dexamethasone to 0.5% levobupivacaine effectively and safely shortens the onset of sensory and motor blockade, increases the duration of sensory and motor blockade without any hemodynamic disturbances.

Keywords: Dexamethasone, Levobupivacaine, nerve stimulator, supraclavicular brachial plexus block.

References

  1. Peripheral nerve blocks: Principles and Practice by AdmirHadzic, Jerry Vloka, New York School of Regional Anaesthesia, 2004; 4: 340.
  2. Hirschel G: Die Anaesthesierung des Plexus Brachialis fuer die Operationen der oberen Extremitaet. Muenchen Med Wochenschr1911; 58: 1555.
  3. Kulenkampff D: Die Anaesthesierung des Plexus Brachialis. Zentralbl Chir 1911; 38: 1337.
  4. Kulenkampff D.,Persky,M.A.Brachial plexus anesthesia:its indications, technique and dangers.Ann.Surg. 1928 june; 87: 833-891.
  5. Lund PC, Cwik JC, Vallesteros F: Bupivacaine- a new long-acting local anesthetic agent. A preliminary clinical and laboratory report. AnesthAnalgl970; 49: 103-14.
  6. Sarma BA, Sundari MR, Suman KVJ, Rao DBVM. Low dose dexmedotomidineas an adjuvant to bupivacaine in supraclavicular brachial plexus block. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2015;14 (6) Ver. II:104-07.
  7. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, Hogan QH. Upper extremity regional anaesthesia. Reg Anesth Pain Med 2009 Mar-Apr;34(2):134-170.
  8. Hickey, Rosemary; Ramamurthy, Somayaji. Brachial plexus block. Current Opinion in Anaesthesiology 1993 Oct;6(5): 799-802.
  9. Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg 2005;101(6):1663-1676.
  10. Choi S, Rodseth R, McCartney CJ. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2014;112(3):427-39.
  11. Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without dexamethasone – a comparative study. International Journal of Scientific and Research Publications. 2012;2(12):1-7.
  12. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. AnesthAnalg2006;102:263‑
  13. Chen SY, Liu FL, Cherng YG, Fan SZ, Leighton BL, Chang HC, et al. Patient controlled epidural levobupivacaine with or without fentanyl for post‑cesarean section pain relief. Biomed Res Int2014;2014:965152.
  14. Cummings KC 3rd, Napierkowski DE, Parra‑Sanchez I, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth2011;107:446‑
  15. Pani N, Routray SS, Mishra D, Pradhan BK, Mohapatra BP, Swain D. A clinical comparison between 0.5% levobupiv-acaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach. Indian J Anaesth2017;61:302-7.
  16. Ritu Baloda, Jatinder Paul Singh Bhupal, Parmod Kumar, Gurjit Singh Gandhi. Supraclavicular Brachial Plexus Block With or Without Dexamethasone as an Adjuvant to 0.5% Levobupivacaine: A Comparative Study. Journal of Clinical and Diagnostic Research. 2016 Jun;10(6): UC09-UC12. Golwala MP, Swadia VN, Dhimar AA, Sridhar NV. Pain relief by dexamethasone as an adjuvant to local anaesthetics in supraclavicular brachial plexus block. J Anaesth Clin Pharmacol 2009; 25(3):285- 8.
  17. Golwala MP, Swadia VN, Dhimar AA, Sridhar NV. Pain relief by dexamethasone as an adjuvant to local anaesthetics in supraclavicular brachial plexus block. J Anaesth Clin Pharmacol 2009; 25(3):285- 8.
  18. Yadav RK, Sah BP, Kumar P, Singh SN. Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study. Kathmandu University Medical Journal 2008; 6(23):302-9.
  19. Hanumansetty K, Hemalatha S, Gurudatt CL. Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries. Int J Res Med Sci 2017;5:1943-7.
  20. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade. Anaesthesia& Analgesia. 2006;102(1):263-7.
  21. Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without dexamethasone – a comparative study. Inter J Scien Rese Pub. 2012;2(12):1-7.
  22. Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamet-hasone improve the quality of intravenous regional anaesthesia and analgesia? A randomized, controlled clinical study. Anesth Analg 2006; 102:605‑
  23. Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular brachial plexus block with and without dexamethasone – A comparative study. Kathmandu Univ Med J (KUMJ). 2003;1:158–60.
  24. Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesth Essays Res 2014;8:202‑
  25. Knezevic NN, Anantamongkol U, Candido KD. Perineural dexamethasone added to local anaesthesia for brachial plexus block improves pain but delays block onset and motor blockade recovery. Pain Physician 2015;18:1-
  26. De Jong RH, Wagman IH, Physiological mechanisms of peripheral nerve block by local anesthetics. Anesthesiology 1963; 24:684-727.

Corresponding Author

Gopal Krishan

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Telephone No.:8979341741