Perineural Low-dose Dexamethasone Added to Infraclavicular Block Anesthesia
Perineural Low-dose Dexamethasone Added to Infraclavicular Block Anesthesia
Dexamethasone has an evidence-based indication in postoperative emesis prophylaxy and as a
 antiinflammatory steroid. Although the perineural administration is off-label, several
 studies recognised its analgetic action as an adjuvant for peripheral nerves blockade,
 permitting to reduce the concentration of the local anesthetics and extending the sensory and
 motor block.Questions remain concerning the mechanism of action, optimal dose, the
 lack/degree of toxicity and the comparison with intravenous administration.The aim of this
 prospective randomized controlled study is to investigate the efficacy of analgesia with 4 mg
 or 2 mg Dexamethasone added to a combination of ropivacaine 0,5% and lidocaine 1% in vertical
 infraclavicular blockade (VIB) anesthesia for upper limb surgery.
The investigators conducted a prospective randomized controlled study in 150 patients
 American Society of Anesthesiologists (ASA) score I-III scheduled for upper limb surgery ,
 divided in 3 groups: group A received anesthesia VIB block with ropivacaine 0,5% 100 mg
 +lidocaine 1%+1 ml saline; group B received VIB block with ropivacaine 0,5% 100 mg +lidocaine
 1% + 2 mg dexamethasone; group C received ropivacaine 0,5% 100 mg +lidocaine 1% + 4 mg
 dexamethasone.The anesthesiologist may use the ultrasound for visual guidance, but should
 also use the nerve stimulator in order to maintain the homogeneity of the procedure.

 Intraoperative sedation was provided with intermittent bolus 10-20 mg IV Propofol.
 Postoperatively all patients received the same analgetic protocol when Visual Analog Pain
 Scale (VAS) over 3 with IV Perfalgan and Lornoxicam 8 mg/12 hours for 24 hours. If after 30
 minutes VAS is still over 3, a loading dose of morphine 0,05 mg/kg should be administered. At
 first analgetic request, the nurse conducts an ice-probe test to both arms and will note the
 answer: same cold, slightly burn, burn, aching with the reason to test the potentially
 hyperalgesia effect related to ropivacaine. The data recorded are: time to first analgetic
 use, VAS at block regression, ice-probe test, motor and sensitive block duration, glycemic
 variations at 4 h, neurological complications immediately after block, total morphine
 consumption.
Inclusion Criteria:

 -  ASA I-III,

 -  BMI<40,

 -  non-anemic

 Exclusion Criteria:

 -  High risk grade hypertension, chronic renal failure, known allergy to local anesthetic
 or NSAIDs, chronic treatment with steroids, drugs dependency, history of diabetes
 mellitus, ulcer or chronic gastritis, infection on the puncture site, chronic
 obstructive pulmonary disease, neuropathy at the surgical level