Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine

Pain after shoulder surgery is often treated with interscalene nerve blocks. Single-injection blocks are effective, but time-limited. Adjuncts such as dexamethasone may help. We thus tested the hypothesis that adding dexamethasone significantly prolongs the duration of ropivacaine and bupivacaine an...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2011-09, Vol.107 (3), p.446-453
Main Authors: Cummings, K.C., Napierkowski, D.E., Parra-Sanchez, I., Kurz, A., Dalton, J.E., Brems, J.J., Sessler, D.I.
Format: Article
Language:English
Subjects:
Adult
Aged
Amides - pharmacology
anaesthetic techniques, regional
anaesthetics local, bupivacaine
anaesthetics local, ropivacaine
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Local - pharmacology
Biological and medical sciences
Bupivacaine - pharmacology
Dexamethasone - pharmacology
Double-Blind Method
Female
hormones, glucocorticoid
Humans
Male
Medical sciences
Middle Aged
Nerve Block
Pain, Postoperative - prevention & control
Proportional Hazards Models
Shoulder - surgery
Time Factors
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Summary:Pain after shoulder surgery is often treated with interscalene nerve blocks. Single-injection blocks are effective, but time-limited. Adjuncts such as dexamethasone may help. We thus tested the hypothesis that adding dexamethasone significantly prolongs the duration of ropivacaine and bupivacaine analgesia and that the magnitude of the effect differs among the two local anaesthetics. In a double-blinded trial utilizing single-injection interscalene block, patients were randomized to one of four groups: (i) ropivacaine: 0.5% ropivacaine; (ii) bupivacaine: 0.5% bupivacaine; (iii) ropivacaine and steroid: 0.5% ropivacaine mixed with dexamethasone 8 mg; and (iv) bupivacaine and steroid: 0.5% bupivacaine mixed with dexamethasone 8 mg. The primary outcome was time to first analgesic request after post-anaesthesia care unit discharge. The Kaplan–Meier survival density estimation and stratified Cox’s proportional hazard regression were used to compare groups. Dexamethasone significantly prolonged the duration of analgesia of both ropivacaine [median (inter-quartile range) 11.8 (9.7, 13.8) vs 22.2 (18.0, 28.6) h, log-rank P
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aer159