Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade

Abstract

Purpose: We conducted ultrasound-guided single-shot supraclavicular blockade and investigated the analgesic effect of dexamethasone added to levobupivacaine. The aim of this study was to determine whether the addition of low-dose dexamethasone to levobupivacaine would prolong the duration of analgesia sufficiently to avoid additional intravenous analgesic use for the first 24 hours postoperatively.

Methods: This randomised controlled study assessed 70 patients undergoing upper-extremity surgery. Patients were eligible if there 18 years or over with American Society of Anaesthesiologists (ASA) physical status I, II or III. Patients were randomly assigned to receive 25 ml 0.5% levobupivacaine plus four milligrams dexamethasone (group 1) or 25 ml 0.5% levobupivacaine plus one millilitre saline (group 2). Pain scores, analgesic consumption and time estimation at which they perceived that sensory and motor blockade started and resolved were recorded.

Results: Duration of sensory (1,260 min. in group 1 vs 600 min. in group 2) and motor (1,200 min. in group 1 vs 700 min. in group 2) blockade were significantly longer in group 1 (P < 0.05). Postoperative pain levels in group 1 were significantly lower (P < 0.05) at all investigation times. Analgesia consumption was significantly lower (P < 0.05) in group 1; at six and 12 hours, no patient required additional analgesia, and at 24 hours, only two patients compared with 17 in the levobupivacaine group required additional analgesia.

Conclusion: Using single-shot low-dose dexamethasone in a mixture with levobupivacaine results in prolonged analgesia duration and less analgesic use compared with levobupivacaine alone.

Fig. 1

Consolidated Standards of Reporting Trials (CONSORT) flow diagram of participants

Fig. 2

Number of patients receiving analgesia. *P < 0.05