A Comparison of Ropivacaine Alone Versus Combination of Dexamethasone and Clonidine for Block
Condition: Upper Extremity Surgery
Study type: Observational

Summary: 
      The aim of this randomized, observer-blinded study is to evaluate the postoperative analgesic
      efficacy of adding dexamethasone and clonidine to ropivacaine in supraclavicular nerve block.
      The investigators hypothesized that addition of dexamethasone and clonidine to ropivacaine
      would prolong the duration of analgesia in supraclavicular nerve block compared with
      ropivacaine alone.
    

Detailed description: 
      Subjects undergoing orthopedic surgery of upper extremities were randomized to be one of the
      three groups to receive supraclavicular nerve block with group 1: ropivacaine alone; group 2:
      ropivacaine and dexamethasone; group 3: ropivacaine and clonidine or group 4: ropivacaine and
      dexamethasone and clonidine combination.

      Subjects were identified at the day surgery unit at Parkland hospital before the procedure
      and approached by their physician, the primary investigator, or research personnel for the
      consent for the study. If the subjects chooses and consents fully to participate, he or she
      was randomly assigned to receive one of the previously described local anesthetics for
      supraclavicular nerve block.

      The following clinical outcomes were assessed for up to 24 hr: Duration of the block, onset
      of the block, postoperative pain scores, nausea, vomiting, and complications of peripheral
      nerve block. Pain was evaluated by using a linear 10-cm visual analog scale (VAS; 0=no pain,
      10= worst imaginable pain) immediately before the block, 5, 10, 15 minutes and
      postoperatively on the arrival of Post Anesthesia Care Unit (PACU) within 15 minutes,
      discharge from the Day surgery Unit, and 24 hr. later at home via phone call visit.

      Sensory and motor block in the related nerve dermatomes were assessed. Patient was instructed
      to document at what time did hand motion (finger movement) return and what time normal
      sensation return. Specific time for both events was sked to patient at phone call visit 24 hr
      later. Overall patient satisfaction was evaluated at the discharge from the day surgery and
      24 hr after the block via phone visit.

      At any point in which the patient is not experiencing pain relief after having received the
      injection, they were removed from the study and other anesthetic techniques will be applied
      to resolve their pain along with pharmacological management of their pain. Rescue antiemetic,
      which is standard of care, will be given to any patient who complains of nausea or vomiting.
    

Intervention name(s): Ropivacaine; Ropivacaine and dexamethasone; Ropivacaine and clonidine; Ropivacaine, dexamethasone and clonidine
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): Ropivacaine alone; Ropivacaine combination with dexamethasone; Ropivacaine combination with clonidine; Ropivacaine combination with dexamethasone and clonidine
Other intervention name(s): Noropin; Noropin and adjuvant; Noropin and adjuvants; Noropin and adjuvants
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Clonidine; Ropivacaine; BB 1101
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Subjects who scheduled to undergo upper extremity surgery requiring USSB for postoperative
        analgesia with ropivacaine alone or ropivacaine and adjuvants.
      
Keywords: Supraclavicular block; Ropivacaine; Dexamethasone; Clonidine; Postoperative analgesia