Perineural Low-dose Dexamethasone Added to Infraclavicular Block Anesthesia
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 3

Summary: 
      Dexamethasone has an evidence-based indication in postoperative emesis prophylaxy and as a
      antiinflammatory steroid. Although the perineural administration is off-label, several
      studies recognised its analgetic action as an adjuvant for peripheral nerves blockade,
      permitting to reduce the concentration of the local anesthetics and extending the sensory and
      motor block.Questions remain concerning the mechanism of action, optimal dose, the
      lack/degree of toxicity and the comparison with intravenous administration.The aim of this
      prospective randomized controlled study is to investigate the efficacy of analgesia with 4 mg
      or 2 mg Dexamethasone added to a combination of ropivacaine 0,5% and lidocaine 1% in vertical
      infraclavicular blockade (VIB) anesthesia for upper limb surgery.
    

Detailed description: 
      The investigators conducted a prospective randomized controlled study in 150 patients
      American Society of Anesthesiologists (ASA) score I-III scheduled for upper limb surgery ,
      divided in 3 groups: group A received anesthesia VIB block with ropivacaine 0,5% 100 mg
      +lidocaine 1%+1 ml saline; group B received VIB block with ropivacaine 0,5% 100 mg +lidocaine
      1% + 2 mg dexamethasone; group C received ropivacaine 0,5% 100 mg +lidocaine 1% + 4 mg
      dexamethasone.The anesthesiologist may use the ultrasound for visual guidance, but should
      also use the nerve stimulator in order to maintain the homogeneity of the procedure.

      Intraoperative sedation was provided with intermittent bolus 10-20 mg IV Propofol.
      Postoperatively all patients received the same analgetic protocol when Visual Analog Pain
      Scale (VAS) over 3 with IV Perfalgan and Lornoxicam 8 mg/12 hours for 24 hours. If after 30
      minutes VAS is still over 3, a loading dose of morphine 0,05 mg/kg should be administered. At
      first analgetic request, the nurse conducts an ice-probe test to both arms and will note the
      answer: same cold, slightly burn, burn, aching with the reason to test the potentially
      hyperalgesia effect related to ropivacaine. The data recorded are: time to first analgetic
      use, VAS at block regression, ice-probe test, motor and sensitive block duration, glycemic
      variations at 4 h, neurological complications immediately after block, total morphine
      consumption.
    

Intervention name(s): Dexamethasone; Ropivacaine; Paracetamol; Morphine; Lidocaine
Intervention type(s): Drug; Drug; Drug; Drug; Drug
Intervention description(s): One hour before surgery the patients received single shot VIB block with the mixture according to the group allocation; One hour before surgery the patients received single shot VIB block with the mixture according to the group allocation; After the block regression, at the first analgetic request the patients received the same analgesia protocol; After the block regression, at the first analgetic request the patients received the same analgesia protocol; One hour before surgery the patients received single shot VIB block with the mixture according to the group allocation
Other intervention name(s): Decadron; Naropin; Perfalgan; Morphine Sulfate ER; Xylocaine
Intervention MeSH terms: Acetaminophen; Dexamethasone; Lidocaine; Morphine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment