Raman Naresh kumar
Perineural dexamethasone appears to prolong the duration of analgesia after brachial plexus block when combined with local anaesthetics. Several studies have compared intravenous with perineural dexamethasone in upper extremity surgeries, however there is concern regarding potential neural toxicity of perineural dexamethasone; Therefore we aimed to find out whether intravenous dexamethasone compared to perineural dexamethasone had similar or superior effects in prolonging the duration of nerve block, as adjuvant to local anaesthetic brachial plexus block.
This randomized, prospective observational study was conducted on 222 patients,in govt.medical college hospital, thiruvananthapuram, posted for upperlimb forearm surgeries under supraclavicular brachial plexus block with duration of analgesia as the primary outcome. The Study period was from December 2016 to June 2018 (1.5 years) after getting clearance from Institutional Ethics Committee and study duration was 1 ½ years. Analysis was done using Excel 2007 worksheet and SPSS 16 statistical software Qualitative data were expressed in proportion and percentage. Quantitative data expressed as mean and SD. Bivariable analysis was done using students t-test and chi-square test. The supraclavicular block lasted significantly longer in patients who received intravenous dexamethasone compared with perineural dexamethasone (p=0.001).With respect to secondary outcomes, there was a reduction in total post operative morphine equivalent administration in perineural dexamethasone compared with intravenous dexamethasone (p = 0.002).We have concluded that 8 mg of intravenous dexamethasone extended the duration of analgesia and reduced pain scores. We suggest that intravenous dexamethasone be preferred, as its use is licensed and the possibility of neurotoxicty is avoided.
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