Abstract
Ropivacaine is one of the most frequently used local anaesthetic for peripheral nerve blocks. It has the drawback of delayed onset of sensory and motor block. Dexamethasone is a very potent glucocorticoid with very good anti-inflammatory and analgesic activity. In this study we observed, compared and evaluated block characteristics when Ropivacaine alone and ropivacaine with dexamethasone were used for supraclavicular block. A total of 80 adult patients undergoing elective forearm surgery under supraclavicular brachial plexus blockade using nerve stimulator were included in the study. Patients were randomly allocated to the two groups of 40 each. Group A received 30ml of 0.5% ropivacaine with distilled water (2ml). Group B received 30ml of 0.5%ropivacaine with 8mg dexamethasone (2ml). Onset and duration of sensory block, motor block and analgesia were assessed. Data analysed using IBM SPSS Statistics 20.0 software and P < 0.05 was considered as statistically significant. Mean sensory onset time in group A was 4.05 ± 0.678 min and in group B was3.60±.383 min (p <0.05). Mean motor onset time in group A was 5.58±0 .418 min and in group B was 4.75±0.308 min (p <0.05). Mean duration of sensory block in group A was 579.18 ± 111.454 min and in group B was 1174.70±7.690 min (p <0.05). Group A had a mean duration of motor block of 489.38 ± 80.329 min and 1085.82±36.070 min in group B (p <0.05).Duration of analgesia of group A was 647.72 ± 91.743 min and in group B was 1202.00 ±14.881 min (p <0.05).
Conclusion: The study demonstrates that Ropivacaine with dexamethasone as adjuvant produces faster onset and better sensory and motor blockade as well as longer duration of analgesia than with Ropivacaine and distilled water.
Keywords: Ropivacaine, dexamethasone, supraclavicular brachial plexus block, nerve stimulator, forearm surgery
References
- Terese T.H, Sandra L.K, Denise J.W. Peripheral nerve blocks. In: Miller.R.D editor. Miller’s Anesthesia. 8th ed. Philadelphia : Elsivier Saunders;2015;1721-51
- Yadav RK, Sah BP, Kumar P, Singh SN, et al., Effectiveness of addition of neostigmine or dexamethasone to local anesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study. Kathmandu University Medical Journal 2008;6(1):302-309.
- Pham – Dang C, Gunst J, Gouin J, Gouin F, Poirier P, Touchais S, et al, A novel Supraclavicular Approach to Brachial Plexus Block, Anesth Analg 1997;85:111–16.
- Dalens B, Vanneuville G, Tanguy A, A new parascalene approach to the brachial plexus in Children: Comparison with the supraclavicular approach, Anesth Analg 1987;66:1264–71
- Lawrence LB .Local anesthetics. In: Goodman and Gilman’s The pharmacological basis of therapeutics.12th edition, 2011; 572-608
- Honorio T. Benzon, Epidural Steroids. In P. Prithvi Raj. Pain medicine, a comprehensive review. Mosby publications 1999.p.259 – 263.
- Shrestha BR, Maharjan SK, Tabedar S et al., Supraclavicular brachial plexus block with and without dexamethasone - a comparative study. Kathmandu Univ Med J (KUMJ). 2003 Jul-Sep;1(3):158-60.
- Shrestha BR, Mahajan SK, Shrestha G, Goutham B, et al., Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. J Nepal Med Assoc 2007;46(168):158- 64.
- Islam SM, Hossain MHMD, Maruf AA,et al., Effect of addition of Dexamethasone to local anesthetics in supraclavicular brachial plexus block. JAFMC Bangladesh 2011;7(1):11–14.
- Hansen TG. Ropivacaine: a pharmacological review. Expert review of neurotherapeutics. 2004 Sep 1;4(5):781-91.
- De Jong RH, Wagman IH. Physiological mechanism of peripheral nerve block by local anesthetics. Anesthesiology 1963;24:684–727.
- Hirschel, “Anesthesia of the brachial plexus for operations on the upper,” München Med Wochenschr, vol. 58, pp. 1555–1556, 1911.
- Bazin JE, Massoni C, Bruelle P, Fenies V, Groslier D, Schoeffler P. The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil. Anaesthesia. 1997 Sep 1;52(9):858-62.
- Chattopadhyay S, Mitra LG, Tramadol as an adjuvant for Brachial plexus block, J Anaeth Clin Pharmacol, 2007;23(2):187–9.
- Kothari D, Supraclavicular Brachial Plexus Block, Indian J Anaesth, 2003;47(4):287–288
- Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without Dexamethasone –A Comparative Study. International Journal of Scientific and Research Publications, December: 2012;2(12):1–7.
- Attardi B, Takimoto K, Gealy R et.al: Glucocorticoid induced upregulation of a pituitary K+ channel mRNA in vitro and in vivo. Receptors channels 1: 287-93; 1993.
Corresponding Author
Dr Sunil. R
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