Ram Kesa, Deganwa Mangilal, Verma Kalpana, Bharadwaj Avnish, Mathur Vijay, Saraswat Rajkumar K
Anesthesiology, Mahatma Gandhi Medical College and Hospital, Jaipur, IND.
Anesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, IND.
Cureus. 2025 Apr 3;17(4):e81658. doi: 10.7759/cureus.81658. eCollection 2025 Apr.
BACKGROUND: Regional anesthesia techniques, such as brachial plexus blocks, are widely used for upper limb surgeries. The costoclavicular approach is a relatively new technique that targets the brachial plexus cords in a compact arrangement. Adjuvants like dexamethasone have been shown to enhance the efficacy of local anesthetics in various regional blocks, but studies regarding their effect in costoclavicular brachial plexus block (CCB) with levobupivacaine are limited. OBJECTIVE: The objective of this study is to compare the efficacy of 0.5% levobupivacaine alone versus 0.5% levobupivacaine with dexamethasone as an adjuvant for CCB in patients undergoing upper limb surgeries. METHODS: This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing elective upper limb surgeries. Patients were randomly allocated into two groups: Group A (n = 30) received 18 mL of 0.5% levobupivacaine with 2 mL of normal saline, while Group B (n = 30) received 0.5% levobupivacaine 18 mL with dexamethasone 2 mL (8mg). The primary outcome was the onset of sensory blockade. Secondary outcomes included the onset of motor blockade, duration of sensory and motor blockade, time to first analgesic request, and complications. RESULTS: The dexamethasone group (Group B) demonstrated a significantly faster onset of both sensory (median 7 vs 9 minutes, p<0.01) and motor (median 11 vs 15.5 minutes, p<0.01) blockade. The duration of sensory (median 865 vs 496.5 minutes, p<0.01) and motor (median 840 vs 420 minutes, p<0.01) blockade was substantially prolonged in the dexamethasone group (Group B). Time to first analgesic request was significantly delayed in the dexamethasone group (median 847 vs 514 minutes, p<0.01). No significant complications were reported in either group. CONCLUSION: The addition of dexamethasone to 0.5% levobupivacaine for CCB significantly enhances block efficacy, providing faster onset and prolonged duration, and extends postoperative analgesia compared to 0.5% levobupivacaine alone. This combination of levobupivacaine and dexamethasone can be a valuable option for optimizing regional anesthesia in upper limb surgeries.
背景：区域麻醉技术，如臂丛神经阻滞，广泛应用于上肢手术。锁骨下途径是一种相对较新的技术，可针对紧密排列的臂丛神经束。已证明地塞米松等佐剂可增强局部麻醉药在各种区域阻滞中的效果，但关于其在左旋布比卡因锁骨下臂丛神经阻滞（CCB）中的作用的研究有限。 目的：本研究的目的是比较0.5%左旋布比卡因单独使用与0.5%左旋布比卡因联合地塞米松作为佐剂用于上肢手术患者CCB的效果。 方法：这项前瞻性、随机、观察者盲法对照试验纳入了60例接受择期上肢手术的患者。患者被随机分为两组：A组（n = 30）接受18 mL 0.5%左旋布比卡因加2 mL生理盐水，而B组（n = 30）接受18 mL 0.5%左旋布比卡因加2 mL地塞米松（8mg）。主要结局是感觉阻滞的起效时间。次要结局包括运动阻滞的起效时间、感觉和运动阻滞的持续时间、首次要求镇痛的时间以及并发症。 结果：地塞米松组（B组）感觉阻滞（中位时间7分钟对9分钟，p<0.01）和运动阻滞（中位时间11分钟对15.5分钟，p<0.01）的起效明显更快。地塞米松组（B组）感觉阻滞（中位时间865分钟对496.5分钟，p<0.01）和运动阻滞（中位时间840分钟对420分钟，p<0.01）的持续时间显著延长。地塞米松组首次要求镇痛的时间显著延迟（中位时间847分钟对514分钟，p<0.01）。两组均未报告明显并发症。 结论：在CCB中，0.5%左旋布比卡因添加地塞米松可显著提高阻滞效果，起效更快，持续时间延长，与单独使用0.5%左旋布比卡因相比，术后镇痛时间延长。左旋布比卡因和地塞米松的这种组合可能是优化上肢手术区域麻醉的一个有价值的选择。
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