Low-dose Intravenous Dexamethasone at Different Times as Adjunvants for Brachial Plexus Blocks
Condition: Analgesia; Dexamethasone; Brachial Plexus Block; Intravenous Drug Usage; Time; Shoulder Surgery
Study type: Interventional
Phase: Phase 4

Summary: 
      Dexamethasone has been tested as an effective adjuvant to prolong the effect of local
      anesthetics for peripheral nerve blocks, both perineurally and intravenously. The purpose of
      this study is to investigate the effect of the addition of dexamethasone (5mg) at different
      time to a standard ropivacaine solution (0.5%) on analgesic duration of interscalene block.
    

Detailed description: 
      Interscalene brachial plexus block (ISB) is regarded as the standard of care for anesthesia
      and analgesia for shoulder surgery by providing the superior analgesia and reducing opioid
      consumption. After several hours when the effects of single injection ISB wear off, the
      patients often suffer moderate to severe pain of the surgical insult and required strong
      opioid analgesia. Efforts to prolong ISB duration by adding adjuvants to local anesthetic
      (eg. clonidine, dexmedetomidine) have been studied with promising results. Dexamethasone, has
      been added to local anesthetic solutions for ISB and has demonstrated promise in preliminary
      studies. Perineural dexamethasone (8-10mg) in conjunction with local anesthetic prolongs the
      duration of ISB with an effect sizes ranging from 40% to 75% (absolute effect ~ 6 to 10
      hours). Dexamethasone, however, is only approved for intramuscular or intravenous
      administration and therefore perineural use is currently off-label. Intravenous
      administration of dexamethasone was reported to have similar effects as perineural route
      indicating the possible mechanism for prolonging analgesic duration might be due to the
      systemic effects of dexamethasone. We hypothesized: should that is the reason, systemic
      administration of dexamethasone at different time may provide similar effects on the duration
      of peripheral nerve block. Dexamethasone is a slow effect cortisone with long half-time, it
      is widely used at the beginning of surgery to prevent postoperative nausea and vomiting. A
      trial that demonstrates enhanced block quality and duration associated with intravenous
      dexamethasone at different time may allow us to achieve prolonged duration of effect if
      dexamethasone is used in perioperative period for different purpose. This would further
      identify the possible mechanism of dexamethasone to prolong the analgesia effect of local
      anesthetics.
    

Intervention name(s): dexamethasone
Intervention type(s): Drug
Intervention description(s): Intravenous administration of dexamethasone at different time for the duration of ISB with 0.5% ropivacaine
Other intervention name(s): Dexamethasone Dexamethasone sodium phosphate
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Dexamethasone 21-phosphate; BB 1101
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment