Dexamathasone added to levobupivacaine improves postoperative analgesia in ultrasound guided interscalene brachial plexus blockade for arthroscopic shoulder surgery

Abstract

Background: The purpose of this study was to evaluate the effect of the addition of 5 mg dexamethasone to 10 ml of 0.5% levobupivacaine on postoperative analgesic effects of ultrasound guided-interscalene brachial plexus block (ISBPB) in arthroscopic shoulder surgery under general anesthesia.

Methods: In 60 patients scheduled for arthroscopic shoulder surgery that underwent general anesthesia, ISBPB was preoperatively performed with 10 ml of 0.5% levobupivacaine under the guidance of ultrasound and a nerve stimulator. Patients were randomly allocated to receive the same volume of normal saline (Group I), 5 mg of dexamethasone (Group II), or 1 : 400,000 epinephrine (Group III) as an adjuvant to the mixture. A blind observer recorded total analgesic consumption, sleep quality, complication, and patient satisfaction using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, 48 h after the operation.

Results: All patients had successful ISBPB and excellent analgesic effects less than VNRS 4 up to discharge time. VNRS in Group II at 12 h and 48 h was statistically much lower than in Group I and III. There were no differences in total analgesic consumption, sleep quality, complications, and patient satisfaction.

Conclusions: We conclude that the addition of 5 mg of dexamethasone to 10 ml of 0.5% levobupivacaine in ISBPB showed improvement of postoperative analgesia for arthroscopic shoulder operation without any specific complications.

Keywords: Analgesia; Brachial plexus blocks; Dexamethasone; Levobupivacaine; Ultrasound.

Fig. 1

Verbal numerical rating scale (VNRS) according to the time interval after arthroscopic shoulder surgery. Values are expressed as mean ± SD. ^*P < 0.05 compared with Group I. Group I: 1 ml normal saline as an adjuvant to 10 ml of 0.5% levobupivacaine for interscalene brachial plexus blockade, Group II: 1 ml of 5 mg dexamethasone as an adjuvant to 10 ml of 0.5% levobupivacaine for interscalene brachial plexus blockade, Group III: 1 : 400,000 epinephrine as an adjuvant to 10 ml of 0.5% levobupivacaine for interscalene brachial plexus blockade.