The Effect of Intravenous Dexamethasone on Rebound Pain After Interscalene Brachial Plexus Block for Shoulder Surgery
Condition: Rebound Pain
Study type: Interventional

Summary: 
      The rebound pain after nerve block could interfere with the patient's recovery and
      rehabilitation. It is not known how intravenous dexamethasone affects rebound pain. This
      study aims to evaluate the effect of intravenous dexamethasone on rebound pain after
      interscalene block for shoulder surgery.
    

Detailed description: 
      Shoulder rotator cuff repair and acromioplasty are associated with severe postoperative pain.
      The interscalene block (ISB) is commonly used for this type of surgery, providing analgesia
      by anesthetizing the nerves that supply the shoulder. Although the nerve block provides
      extremely effective analgesia for the first 6-8 hours, patients experience severe pain once
      its effect has been wearing off. Rebound pain is a severe pain that occurs when the effect of
      a nerve block disappears in a patient during the postoperative period. The purpose of this
      study is to investigate whether the use of intravenous dexamethasone reduces rebound pain in
      patients recruiting for shoulder surgery with interscalene brachial plexus blockade.

      This study will be conducted as a single-center, prospective, randomized, double-blinded
      trial in a university hospital. Patients scheduled for elective shoulder surgery will be
      screened for enrollment in the study. All subjects will undergo ultrasound-guided
      interscalene nerve block before induction of general anesthesia. They will be randomly
      assigned into the two groups which use intravenous dexamethasone or not. An anesthesiologist
      who will perform blocks will not involve in the data collection. Other health care workers
      who will involve in the evaluation of postoperative pain scores, nausea and vomiting, opioid
      consumption, quality of Sleep, and Quality of Recovery score will be blinded to the group
      assignment.
    

Intervention name(s): Group C; Group Dex
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients will receive 2 mg midazolam and 50 ug fentanyl for sedation before the block procedure. Each patient will be positioned appropriately, then a high-frequency linear array transducer (13-6 MHz) will be placed in the interscalene region to define the brachial plexus on the short axis. Under sterile conditions, a 50 mm block needle will be advanced into the interscalen area using the in-plane method. After localization and negative aspiration, 15 ML of 5% bupivacaine drug will be injected into the interscalene area. 100 ml of NACI will be given intravenously within 15 minutes.
General anesthesia will be performed using 2 mg/kg of propofol and 1-2 µg/kg of fentanyl. Tracheal intubation will be facilitated with 0.6mg/kg rocuronium. Anesthesia will be maintained using 50% oxygen and 2% sevoflurane. Patients will be extubated into the operating room after reversing residual muscle relaxation. A multimodal analgesia regimen will be applied postoperatively.; Patients will receive 2 mg midazolam and 50 ug fentanyl for sedation before the block procedure. Each patient will be positioned appropriately, then a high-frequency linear array transducer (13-6 MHz) will be placed in the interscalene region to define the brachial plexus on the short axis. Under sterile conditions, a 50 mm block needle will be advanced into the interscalene area using the in-plane method. After localization and negative aspiration, 15 ML of 5% bupivacaine drug will be injected into the interscalene area. 5 mg dexamethasone intravenously will be given in 100 ml NACI within 15 minutes.
General anesthesia will be performed using 2 mg/kg of propofol and 1-2 µg/kg of fentanyl. Tracheal intubation will be facilitated with 0.6mg/kg rocuronium. Anesthesia will be maintained using 50% oxygen and 2% sevoflurane. Patients will be extubated into the operating room after reversing residual muscle relaxation. A multimodal analgesia regimen will be applied postoperatively.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: interscalene brachial plexus block; shoulder surgery; dexamethasone