A study on the effects of dexamethasone added to levobupivacaine during infraclavicular brachial plexus blockade with USG

A Study on the Effects of Dexamethasone Added to Levobupivacaine during Infraclavicular Brachial Plexus Blockade with USGPurpose: In our study, we aimed to research the postoperative analgesic effects of 8 mg dexamethasone addition to 0.5% levobupivacaine (200 mg) during infraclavicular brachial plexus blockade with USG.Materials and Methods: After written approvals were taken from the ethical council of our faculty and the cases, orthopedic patients who are planned to be subjected to upper extremity surgery were included in the scope of the study, and infraclavicular brachial plexus blockade with USG was applied to 40 patients in total.The patients were divided into two groups and a total amount of 200 mg of levobupivacaine (0.5% in 40 ml) was used for the patients in Group I. In Group II, 8 mg of dexamethasone was added to the same dose and volume of levobupivacaine. Blockade was applied through the infraclavicular technique, under the guidance of peripheral nerve stimulator and with USG. Surgery start time after the start of the procedure, and sedation and analgesia levels were evaluated by use of Visual Analog Scale and Verbal Rating Scale (VAS, VRS) and recorded. Hemodynamical parameteres were measured and recorded on 5th, 10th, 15th, 30th, 45th, 60th, 90th and 120th minutes before and after the blockade. Development of nausea, vomiting and respiratory depression were monitored on the patients during the operation and also in the postoperative recovery room. Patients having nausea and vomiting were planned to be given 4 mg of Ondansetron IV (intravenous). Pain start times of the patients were asked and the answers were recorded when they were visited on the postoperative second day. They were advised to take oral tramadol HCl when pain develops. Chi-square test statistics were used for making comparisons between the categorical measurement results of the two groups. For comparing the quantitative measurements between the two groups, independent group T test (Student T test) was applied when the hypotheses were confirmed, and Mann Whitney U test was applied in other cases. On the other hand, Repeated Measurements Analysis was used for the evaluation of the changes in time. p values lower than 0.05 were accepted to be statistically significant.Findings: Demographical data of the two groups were determined to be similar and a significant difference was not found between them. Surgery start time was measured to be 38 ± 4.1 minutes for Group I and 28.75 ± 3.19 minutes for Group II, and the difference between the groups were calculated to be significant (p<0.001). Based on the results, surgery start time was longer in Group I when compared with the other group. Any statistically significant difference was not observed between the preoperative and postoperative VAS, VRS and sedation values of the two groups (p > 0.05). Postoperative pain start times were determined to be 18 ± 3.58 hours for Group I and 31 ± 1.55 hours for Group II, and the difference was calculated to be statistically significant. As another finding about the additional analgesic administration start times, while all patients in Group I needed additional analgesic administration in the first 24 hours, any need of additional analgesics did not occur in the first 30 hours for Group II, and the difference between the groups were significant (p < 0.01). Any side affect was not observed on any of the cases in terms of nausea, vomiting, itching, respiratory depression or horner syndrome.Conclusion: As a result of the study, it is concluded that shorter surgery start times and longer postoperative analgesia can be provided by the addition of 8 mg of dexamethasone to 0.5% of levobupivacaine in infraclavicular brachial plexus blockade.Keywords: Levobupivacaine, Infraclavicular Brachial Plexus Blockade, Dexamethasone.