PERINEURAL DEXAMETHASONE VS INTRAVENOUS DEXAMETHASONE: SUPRACLAVICULAR BRACHIAL PLEXUS BLOCKS (BPB) IN UPPER LIMB SURGERIES
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Abstract
Background: The supraclavicular brachial plexus block (BPB) is a reliable method for upper limb surgeries below the shoulder, especially in patients with cardiorespiratory issues. Ultrasound guidance enhances safety and accuracy, and local anaesthetics provide effective but temporary analgesia. Pain relief is extended by adjuvants like dexamethasone, but intravenous (IV) dexamethasone is being researched as a potentially safer, off-label alternative with potential systemic anti-inflammatory benefits.
Objective: To compare perineural dexamethasone with intravenous dexamethasone in treating postoperative pain in those patients who were having elective surgery of the upper limbs with supraclavicular brachial plexus block
Study design: A comparative study
Duration and place of study: This study was conducted from November 2023 to November 2024 at Rahim Yar Khan Medical College / Hospital Rahim Yar Khan Pakistan.
Methodology: This research involved 60 patients between the age of 18 and 60 years who were all ASA physical status I or II and had elective upper limb cancer surgery with supraclavicular brachial plexus block (BPB). The subjects were divided into two groups: Group A had perineural dexamethasone with bupivacaine, while Group B had intravenous dexamethasone with perineural saline and bupivacaine.
Results: There were a total of 60 patients elected for this study according to the inclusion criteria. All the participants were divided into 2 groups, each having 30 individuals. The mean age in the perineural group was 52.5 yrs while it was 51.3 in the systemic group. Table number 1 shows the demographics and their distribution in both the groups. The time to onset of both sensory and motor block was much higher in the systemic compared with the perineural group. In the perineural group, six patients needed one dose of morphine, while four needed a second dose. In the systemic group, 18 patients needed one dose of morphine, of whom 10 needed a second dose.
Conclusion: In ultrasound-guided supraclavicular BPB, perineural dexamethasone offers longer motor block, sensory block, and postoperative analgesia than intravenous dexamethasone.
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Abdul Majid Khan
Consultant Anaesthesiologist, Rahim Yar Khan Medical College / Hospital Rahim Yar Khan, Pakistan.
Abid Hussain
Specialist Anaesthesia, Department of Anaesthesia & Pain Medicine Royal Commission Hospital, Jubail, Saudi Arabia.
Omar Abdul Hameed Alradhwan
Consultant / Head of Department, Department of Anaesthesia & Pain Medicine, Royal Commission Hospital, Jubail, Saudi Arabia.
Muhammad Sohail Umerani
Consultant Neurosurgeon Department of Neurosurgery, Royal Commission Hospital, Jubail, Saudi Arabia.
Masood Iqbal
Assistant Consultant ICU, King Abdullah Medical City, Makkah, Saudi Arabia.
Husain Saeed
Consultant Anaesthesiologist, Sheikh Zayed Medical Collage/Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan.