Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial

Ryosuke Kawanishi, Kaori Yamamoto, Yoko Tobetto, Kayo Nomura, Michihisa Kato, Ritsuko Go, Yasuo M Tsutsumi, Katsuya Tanaka, Yoshitsugu Takeda, Ryosuke Kawanishi, Kaori Yamamoto, Yoko Tobetto, Kayo Nomura, Michihisa Kato, Ritsuko Go, Yasuo M Tsutsumi, Katsuya Tanaka, Yoshitsugu Takeda

Abstract

Purpose: To determine the effects of intravenous and perineural dexamethasone on the duration of interscalene brachial plexus block (ISB) with ropivacaine in patients undergoing arthroscopic shoulder surgery.

Patients and methods: In this prospective, randomized, placebo-controlled trial, patients presenting for arthroscopic shoulder surgery with an ISB were randomized to receive ropivacaine 0.75% (group C), ropivacaine 0.75% plus perineural dexamethasone 4 mg (group Dperi), or ropivacaine 0.75% plus intravenous dexamethasone 4 mg (group Div). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first request for analgesic.

Results: Thirty-nine patients were randomized. The median times of sensory block in groups C, Dperi, and Div were 11.2 hours (interquartile range [IQR] 8.0-15.0 hours), 18.0 hours (IQR 14.5-19.0 hours), and 14.0 hours (IQR 12.7-15.1 hours), respectively. Significant differences were observed between groups Dperi and C (P=0.001). Kaplan-Meier analysis for the first analgesic request showed significant differences between groups Dperi and C (P=0.005) and between groups Dperi and Div (P=0.008), but not between groups C and Div.

Conclusion: Perineural but not intravenous administration of 4 mg of dexamethasone significantly prolongs the duration of effective postoperative analgesia resulting from a single-shot ISB with ropivacaine 0.75%.

Keywords: dexamethasone; interscalene nerve block; perineural; postoperative pain; ropivacaine.

Figures

Figure 1
Figure 1
Median time to first request for analgesia (hours). Note:※P=0.001 versus Group C. ○outlier.
Figure 2
Figure 2
Kaplan–Meier analysis of time to first request for analgesia in the three patient groups.
Figure 3
Figure 3
Numeric rating scale (NRS) the morning after surgery. Differences among the three groups were statistically significant, but differences between each pair of groups were not. Note:○outlier.

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