Low Dose Dexamethasone for Distal Radius Fractures

Study Overview
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Brief Summary
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The addition of the steroid dexamethasone to a single injection of local anesthetic has been shown to significantly prolong the duration of peripheral nerve blockade compared to local anesthetic alone. This allows for improved post-operative pain scores and reduces opioid use in the early post-operative period. However, the use of a steroid adjuvant in regional nerve blocks is generally not considered standard of care, and there is considerable variation among anesthesiologists regarding preferred formulations and the role of adjuvants in regional anesthesia. A recent study from our institution demonstrated the effectiveness of dexamethasone directly mixed with local anesthetic at multiple doses compared to placebo for upper extremity surgery. With this prospective randomized controlled blinded trial, we hope to definitively establish which method of adjuvant dexamethasone administration is superior in extending the effects of a brachial plexus nerve block.

Official Title
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Efficacy of Direct Versus Peripheral Low-Dose Adjuvant Dexamethasone on Duration and Rebound Pain in Regional Anesthesia for Distal Radius Fracture Fixation: A Prospective Randomized Controlled Blinded Study

Conditions
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Post Operative Pain, Distal Radius Fracture

Intervention / Treatment
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* Drug: Dexamethasone 4mg
* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over the age of 18 undergoing open reduction and internal fixation of a distal radius fracture less than 3 weeks from injury with a volar plate technique American Society of Anesthesiologists (ASA) levels 1 through 3 at time of surgery Opioid naïve patients Exclusion Criteria: History of Drug/opioid/alcohol abuse Polytrauma patients History of inflammatory disorder, infection, dementia, psychiatric/neurological disorder, relevant drug/local anesthesia allergy, relevant chronic upper extremity pain (RSD, fibromyalgia, neuralgia, etc) Excessive BMI Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1: Block with Ropivacaine + Dexamethasone<br>Before surgery an ultrasound guided supraclavicular block with ropivacaine and 4 mg of dexamethasone will be administered | Drug: Dexamethasone 4mg<br>* 4 mg of Dexamethasone will be given before surgery<br>Drug: Ropivacaine<br>* Ultrasound guided supraclavicular block with ropivacaine will be given to patients before surgery<br>|
| Active Comparator: Group 2: Ropivacaine Block + IV Dexamethasone<br>Before surgery an ultrasound guided supraclavicular block with ropivacaine will be administered and patients will receive dexamethasone intravenously | Drug: Dexamethasone 4mg<br>* 4 mg of Dexamethasone will be given before surgery<br>Drug: Ropivacaine<br>* Ultrasound guided supraclavicular block with ropivacaine will be given to patients before surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain control | Measured using participants Visual Analog Scale (VAS) pain scores | 72 hours | 
| Postoperative pain control #2 questionnaire | Measured by asking participants how much medication they take after surgery to help control their pain | 72 hours |