title: Perineural versus intravenous dexamethasone as adjuncts to local anaesthetic brachial plexus block for shoulder surgery.
abstract: This randomised, double-blind, placebo-controlled study compared the effect of perineural with intravenous dexamethasone, both administered concomitantly with interscalene brachial plexus block for shoulder surgery. Patients received 8 mg dexamethasone mixed with ropivacaine in the block injection (n = 42), 8 mg dexamethasone intravenously at the time of the block (n = 37), or intravenous saline (n = 41) at the time of the block. Perineural and intravenous dexamethasone resulted in prolonged mean (SD) duration of block to 16.9 (5.2) h and 18.2 (6.4) h, respectively, compared with 13.8 (3.8) h for saline (p = 0.001). Mean (SD) opioid consumption (morphine equivalents) during the first 24 h after postanaesthesia recovery arrival was 12.2 (9.3) mg in the perineural dexamethasone, 17.1 (15.9) mg in the intravenous dexamethasone and 24.1 (14.3) mg in the saline groups (p = 0.001). Dexamethasone via either route reduced anti-emetic use (p = 0.046). There was no effect on patient satisfaction. These results suggest that both perineural and intravenous dexamethasone are useful adjuncts to ropivacaine interscalene block, with the intravenous route preferred as this avoids the possibility of neural toxicity of dexamethasone.
authors.affiliation: Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Rosenfeld
authors.affiliation: Northland Pain Consultants, Liberty, Missouri, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Ivancic
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Hattrup
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Renfree
authors.affiliation: Department of Research Services, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Watkins
authors.affiliation: Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Hentz
authors.affiliation: Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Gorlin
authors.affiliation: University of Arizona College of Medicine, Phoenix, Arizona, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Spiro
authors.affiliation: Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Trentman
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000577:Amides; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D065527:Brachial Plexus Block / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D012782:Shoulder / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000077212:Ropivacaine; D003907:Dexamethasone