Perineural Dexamethasone Versus Intravenous Dexamethasone as an Adjunct to Local Anaesthetic Mixture in Supraclavicular Brachial Plexus Block: A Prospective Double-Blind Randomized Controlled Study

Introduction Supraclavicular brachial plexus block is most preferred for upper limb surgeries since it produces conduction blockade of the trunks of the brachial plexus. Additives are used with local anaesthetics to enhance the effect of analgesia in patients. Therefore, this study is aimed at comparing the efficacy, onset, and duration of block, intraoperative hemodynamics, and postoperative complications, if any, when dexamethasone is used as an adjuvant in supraclavicular block perineurally and intravenously. Methods Ninety adult patients scheduled for elective forearm and hand surgery were randomly divided into three groups, group P, group I, and group S, which received perineural dexamethasone, intravenous dexamethasone, and normal saline, respectively. Supraclavicular brachial plexus block was administered. Hemodynamic parameters were recorded. Assessment of sensory and motor block was done till complete sensory blockade was achieved. Hemodynamic parameters and onset and duration of sensory and motor block were compared using a one-way analysis of variance (ANOVA) test. A p-value of <0.05 was considered statistically significant. Results Onset of sensory and motor blockade was statistically significantly faster after administering perineural dexamethasone compared to intravenous dexamethasone (p=0.003 and p=0.001) and the control group (p<0.001), respectively. The duration of sensory and motor blockade was statistically significantly longer after perineural dexamethasone compared to intravenous dexamethasone (p<0.001) and the control group (p<0.001), respectively. There were no statistically significant hemodynamic changes among the three groups intraoperatively. Conclusion Dexamethasone as an adjuvant to a local anaesthetic mixture in a supraclavicular block speeds the onset and prolongs the duration of sensory and motor blockade compared to intravenous dexamethasone.