title: A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery.
abstract: We recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0.0001.
authors.affiliation: Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Desmet
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Vanneste
authors.affiliation: Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Reynvoet
authors.affiliation: Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Van Cauwelaert
authors.affiliation: Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Verhelst
authors.affiliation: Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Pottel
authors.affiliation: Department of Anaesthesiology, UZ Leuven, Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Missant
authors.affiliation: Department of Anaesthesiology, UZ Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Van de Velde
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy / Q000379:methods; D065527:Brachial Plexus Block / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D019534:Shoulder Impingement Syndrome / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*
chemical_list: D000759:Adjuvants, Anesthesia; D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D005938:Glucocorticoids; D000077212:Ropivacaine; D003907:Dexamethasone