title: Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Using single-shot low-dose dexamethasone in a mixture with levobupivacaine results in prolonged analgesia duration and less analgesic use compared with levobupivacaine alone.
authors.affiliation: Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Av. G. Suska 6, Zagreb, Croatia, jpersec@xnet.hr.
authors.forename: Jasminka
authors.initials: J
authors.lastname: Persec
authors.forename: Zoran
authors.initials: Z
authors.lastname: Persec
authors.forename: Mario
authors.initials: M
authors.lastname: Kopljar
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zupcic
authors.forename: Livija
authors.initials: L
authors.lastname: Sakic
authors.forename: Iva Korecic
authors.initials: IK
authors.lastname: Zrinjscak
authors.forename: Dragan Korolija
authors.initials: DK
authors.lastname: Marinic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000494:pharmacology / Q000627:therapeutic use*; D001917:Brachial Plexus / Q000187:drug effects; D002045:Bupivacaine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D002968:Clavicle / Q000294:innervation; D003907:Dexamethasone / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D000077554:Levobupivacaine; D008875:Middle Aged; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D003907:Dexamethasone; D000077554:Levobupivacaine; D002045:Bupivacaine