A randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided axillary block.
This randomized double-blinded trial compared the effect of intravenous and perineural dexamethasone (8 mg) on the duration of motor block for ultrasound (US)-guided axillary brachial plexus block (AXB).



Patients undergoing upper limb surgery with US-guided AXB were randomly allocated to receive preservative-free dexamethasone (8 mg) via intravenous (n = 75) or perineural (n = 75) administration. The local anesthetic agent, 1% lidocaine -0.25% bupivacaine (30 mL) with epinephrine 5 µg·mL-1, was identical in all subjects. Operators and patients were blinded to the nature of the intravenous and perineural injectate. A blinded observer assessed the block success rate (i.e., a minimal sensorimotor composite score of 14 out of 16 points at 30 min), block onset time, as well as the presence of surgical anesthesia. Postoperatively, the blinded observer contacted all patients with successful blocks to record the duration of motor block (primary outcome), sensory block, and postoperative analgesia.



No intergroup differences were observed in terms of success rate, surgical anesthesia, and block onset time. Compared to intravenous administration, perineural dexamethasone provided longer mean (SD) durations for motor block [17.5 (4.6) hr vs 12.8 (4.5) hr; mean difference, 4.6 hr; 95% confidence interval [CI], -6.21 to -3.08; P < 0.001], sensory block [17.7 (5.1) hr vs 13.7 (5.0) hr; mean difference, 4.0 hr; 95% CI, -5.77 to -2.27; P < 0.001], and postoperative analgesia [21.1 (4.6) hr vs 17.1 (4.6) hr; mean difference, 4.0 hr; 95% CI, -5.70 to -2.30; P < 0.001].



Compared to intravenous dosing, perineural dexamethasone (8 mg) results in longer durations of sensorimotor block and postoperative analgesia for ultrasound-guided axillary block. This trial was registered at www.clinicaltrials.gov number, NCT02629835.
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Julian
J
Aliste
Department of Anesthesia, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand.
Prangmalee
P
Leurcharusmee
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Phatthanaphol
P
Engsusophon
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Aida
A
Gordon
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Giuliano
G
Michelagnoli
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Chonticha
C
Sriparkdee
Department of Anesthesia, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand.
Worakamol
W
Tiyaprasertkul
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Dana Q
DQ
Tran
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Tom C R V
TC
Van Zundert
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
Roderick J
RJ
Finlayson
Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada. de_tran@hotmail.com.
De Q H
DQH
Tran
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000779:Anesthetics, Local / Q000008:administration & dosage; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D065527:Brachial Plexus Block / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D003907:Dexamethasone