Bindal Deeksha, Narang Neeraj, Mahindra Rekha, Gupta Himanshu, Kubre Jyotsna, Saxena Anudeep
Department of Anesthesiology, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):234-239. doi: 10.4103/aer.AER_2_18.
Dexamethasone as an adjuvant to bupivacaine and ropivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, comparison of effect of dexamethasone (8 mg) when added to these two local anesthetics has not been well studied. This study was conducted to compare analgesic efficacy of dexamethasone as adjuvant to bupivacaine and ropivacaine in SCBP block.
Nerve stimulator-guided SCBP block was given to 120 patients, randomly assigned to one of four groups: ( = 30 in each group) Group B, BD, R, and RD received 30 ml (0.5%) bupivacaine + 2 ml saline, 30 ml (0.5%) bupivacaine + dexamethasone 8 mg, 30 ml (0.5%) ropivacaine + 2 ml saline, and 30 ml (0.5%) ropivacaine + dexamethasone 8 mg, respectively. Time for request of the first rescue analgesic, 24-h analgesic consumption, and different block characteristics were assessed. Student's -test, Chi-square test, ANOVA were used for statistical analysis.
Dexamethasone significantly prolonged time for request of the first rescue analgesic of both ropivacaine (1211.83 ± 32.86 vs. 283.17 ± 7.71 min){ R, RD < 0.001} and bupivacaine (1205.17 ± 34.32 vs. 364.67 ± 16.50 min) {p B, BD < 0.001}. 24-h requirement for rescue analgesics was more in Groups B and R when compared to Groups BD and RD. The increase in duration of analgesia was more when Groups R and RD (928.66 min) were compared than Groups B and BD (840.5 min). Similar results were seen with onset times and duration of sensory and motor block.
The addition of dexamethasone to bupivacaine and ropivacaine in SCBP block prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block, with the effect being stronger with ropivacaine.
地塞米松作为布比卡因和罗哌卡因用于锁骨上臂丛神经阻滞（SCBP）的辅助药物，可延长运动和感觉阻滞时间。然而，将地塞米松（8毫克）添加到这两种局部麻醉剂中的效果比较尚未得到充分研究。本研究旨在比较地塞米松作为布比卡因和罗哌卡因在SCBP阻滞中的辅助药物的镇痛效果。
对120例患者进行神经刺激器引导下的SCBP阻滞，随机分为四组（每组n = 30）：B组、BD组、R组和RD组分别接受30毫升（0.5%）布比卡因+2毫升生理盐水、30毫升（0.5%）布比卡因+地塞米松8毫克、30毫升（0.5%）罗哌卡因+2毫升生理盐水和30毫升（0.5%）罗哌卡因+地塞米松8毫克。评估首次要求使用补救镇痛药的时间、24小时镇痛药消耗量以及不同的阻滞特征。采用学生t检验、卡方检验、方差分析进行统计分析。
地塞米松显著延长了罗哌卡因（1211.83±32.86分钟对283.17±7.71分钟）{R，RD组p<0.001}和布比卡因（1205.17±34.32分钟对364.67±16.50分钟）{B，BD组p<0.001}首次要求使用补救镇痛药的时间。与BD组和RD组相比，B组和R组24小时对补救镇痛药的需求量更大。与B组和BD组（840.5分钟）相比，R组和RD组（928.66分钟）镇痛持续时间的增加更多。感觉和运动阻滞的起效时间和持续时间也有类似结果。
在SCBP阻滞中，将地塞米松添加到布比卡因和罗哌卡因中可延长首次补救镇痛的时间，减少补救镇痛药的需求，感觉和运动阻滞起效更快、持续时间更长，罗哌卡因的效果更强。
