Interscalene Block With Low-dose IV vs. Perineural Dexamethasone for Shoulder Arthroscopy
Condition: Pain; Shoulder Arthroscopy
Intervention: Bupivacaine; Perineural dexamethasone; Intravenous dexamethasone; Intravenous saline; Perineural saline
Intervention description: Dexamethasone in nerve block; Saline in nerve block
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Bupivacaine; BB 1101
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 128.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No

Summary:

      Many patients undergoing ambulatory shoulder arthroscopy experience moderate to severe pain
      after surgery. Finding ways to minimize postoperative pain are ideal. Dexamethasone is a
      corticosteroid that is commonly used to prevent and/or treat nausea and inflammation. The
      addition of higher doses of dexamethasone to nerve blocks, which are injections of local
      anesthetics into the upper shoulder area, has been shown to prolong block duration and reduce
      pain. However, it is unclear whether the advantage of longer pain relief outweighs patient
      dissatisfaction with the prolonged feeling of a numb arm. Furthermore, recent studies have
      shown that systemic, intravenously administered dexamethasone may similarly reduce pain
      levels when compared with dexamethasone in the block. In our study, the investigators propose
      to examine the effect of low-dose IV versus block dexamethasone on interscalene block
      duration in patients undergoing shoulder arthroscopy. Most studies have used 4 mg or more.
      One study suggests that 1 mg may have the same effect as larger doses. Our aims are to
      determine whether the addition of low-dose dexamethasone to a local anesthetic in the block
      can prolong its duration, and whether there are differences in postoperative pain,
      consumption of painkillers, side effects, and satisfaction in patients who received IV or
      block dexamethasone. Patients (128 total) will be randomly assigned to either receive IV or
      block dexamethasone, and postoperative assessments (pain, painkiller use, side effects, block
      duration, satisfaction, complications) will be made via phone at 2, 3, 4 (if needed), and
      7-10 days after surgery. Results from this study will reveal whether patients prefer the
      longer-duration analgesia that may be obtained with low-dose dexamethasone in the block.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients having ambulatory arthroscopic shoulder surgery under ultrasound-guided
             interscalene block (rotator cuffs, acromioplasties, stabilizations, labral repairs,
             etc.)

          -  Age 18-70 years

        Exclusion Criteria:

          -  Contraindication to interscalene block

          -  Known allergy/sensitivity to any study medications

          -  Having taken daily steroids for 10 days or longer anytime during the past year

          -  Body mass index <18 or >40

          -  History of uncontrolled nausea and vomiting with opioids or severe post-op nausea and
             vomiting (to prevent any need for higher doses of IV dexamethasone)

          -  Non-English speaking

          -  Revision procedures

          -  Additional procedures (e.g., removal of hardware, procedures involving other areas,
             etc.)

          -  Planned open procedures

          -  History of diabetes

          -  Arthroscopic irrigation and debridement secondary to infection

          -  Peripheral neuropathies affecting the operative extremity

          -  Having taken opiates daily for 10 days or longer immediately preceding surgery, 3
             times a week for greater than 3 months anytime in the past year, or currently taking
             for anything other than shoulder pain