title: Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study.
abstract: OBJECTIVE
  The study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block.
  
  
  METHODS
  The design is a prospective randomized double-blinded clinical study.
  
  
  METHODS
  The setting is an academic medical center.
  
  
  METHODS
  The patients are 89 adult patients scheduled for shoulder arthroscopy.
  
  
  METHODS
  All patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia.
  
  
  METHODS
  The measurements are the duration of analgesia and motor block.
  
  
  RESULTS
  The median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively (P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend (P = .0247).
  
  
  CONCLUSIONS
  Low-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block.
authors: Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104. Electronic address: Jiabin.liu@uphs.upenn.edu.
authors: Jiabin
authors: J
authors: Liu
authors: Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: Kenneth A
authors: KA
authors: Richman
authors: Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: Samuel R
authors: SR
authors: Grodofsky
authors: Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: Siya
authors: S
authors: Bhatt
authors: Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: George Russell
authors: GR
authors: Huffman
authors: Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: John D
authors: JD
authors: Kelly
authors: Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: David L
authors: DL
authors: Glaser
authors: Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104.
authors: Nabil
authors: N
authors: Elkassabany
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia; D001917:Brachial Plexus; D002045:Bupivacaine / Q000494:pharmacology; D003907:Dexamethasone / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D003907:Dexamethasone; D002045:Bupivacaine
keywords: Adjuvant; Analgesia duration; Brachial plexus nerve block; Dexamethasone; Dose response