Limits...
Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone.

Jadon A, Dixit S, Kedia SK, Chakraborty S, Agrawal A, Sinha N - Indian J Anaesth (2015)

Bottom Line: Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India.

ABSTRACT

Background and aims: Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic.

Methods: After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.

Results: The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).

Conclusion: Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.

No MeSH data available.


Related in: MedlinePlus

Comparative post-operative visual analogue scale scores
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4378078&req=5

Figure 2: Comparative post-operative visual analogue scale scores

Mentions: Patients in both groups were comparable in age, sex (male/female) ratio, weight and height [Table 1]. Onset of sensory block, motor block and onset of surgical anaesthesia were early in Group RD compared with Group R [statistically not significant (Table 2)]. The duration of analgesia was significantly prolonged in the Group RD 1103.72 ± 296.027 min compared to Group R 551.54 ± 166.92 min (P = 0.0001) [Table 2]. VAS scores in the first 4 h were comparable (P > 0.05). VAS scores were significantly higher in the Group R at the end of 8 h, 12 h, 16 h, 20 h and 24 h (P < 0.05). Patients in Group RD showed excellent pain control up to 24 h. and had significantly lower VAS scores (2.5–3.3) compared to Group R (4.2-5.06) (P < 0.05) [Figure 2]. Rescue analgesic consumption was significantly lower in the Group RD (1.22 ± 0.47 analgesic injections) in comparison to Group R (1.9 ± 0.73), (P < 0.001) in the first 24 h post-operatively [Figure 3]. The incidence of side-effects was low and comparable between the groups [Table 3]. HS was observed in 11/50 (22%) in Group RD and 15/50 (30%) in Group R (P > 0.05). Ipsilateral diaphragmatic paresis was seen in (10/50) (20%) in Group RD and (8/50) (16%) in Group R (P > 0.05). Hoarseness of voice due to recurrent laryngeal nerve block was seen in 1/50 (2%) in Group RD and in 2/50 (4%) in Group R (P > 0.05). No major complications like pneumothorax, epidural or spinal injection, intra-arterial injection, any neurological sequale (persistent numbness, paraesthesia or weakness of operative limb) were reported. Two patients (2/50) in Group RD and 1 (1/50) in Group R had external jugular vein puncture, which was managed with external compression and did not require any intervention [Table 3].


Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone.

Jadon A, Dixit S, Kedia SK, Chakraborty S, Agrawal A, Sinha N - Indian J Anaesth (2015)

Comparative post-operative visual analogue scale scores
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4378078&req=5

Figure 2: Comparative post-operative visual analogue scale scores
Mentions: Patients in both groups were comparable in age, sex (male/female) ratio, weight and height [Table 1]. Onset of sensory block, motor block and onset of surgical anaesthesia were early in Group RD compared with Group R [statistically not significant (Table 2)]. The duration of analgesia was significantly prolonged in the Group RD 1103.72 ± 296.027 min compared to Group R 551.54 ± 166.92 min (P = 0.0001) [Table 2]. VAS scores in the first 4 h were comparable (P > 0.05). VAS scores were significantly higher in the Group R at the end of 8 h, 12 h, 16 h, 20 h and 24 h (P < 0.05). Patients in Group RD showed excellent pain control up to 24 h. and had significantly lower VAS scores (2.5–3.3) compared to Group R (4.2-5.06) (P < 0.05) [Figure 2]. Rescue analgesic consumption was significantly lower in the Group RD (1.22 ± 0.47 analgesic injections) in comparison to Group R (1.9 ± 0.73), (P < 0.001) in the first 24 h post-operatively [Figure 3]. The incidence of side-effects was low and comparable between the groups [Table 3]. HS was observed in 11/50 (22%) in Group RD and 15/50 (30%) in Group R (P > 0.05). Ipsilateral diaphragmatic paresis was seen in (10/50) (20%) in Group RD and (8/50) (16%) in Group R (P > 0.05). Hoarseness of voice due to recurrent laryngeal nerve block was seen in 1/50 (2%) in Group RD and in 2/50 (4%) in Group R (P > 0.05). No major complications like pneumothorax, epidural or spinal injection, intra-arterial injection, any neurological sequale (persistent numbness, paraesthesia or weakness of operative limb) were reported. Two patients (2/50) in Group RD and 1 (1/50) in Group R had external jugular vein puncture, which was managed with external compression and did not require any intervention [Table 3].

Bottom Line: Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India.

ABSTRACT

Background and aims: Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic.

Methods: After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.

Results: The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).

Conclusion: Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.

No MeSH data available.


Related in: MedlinePlus