Comparison of Intravenous Dexamethasone versus Perineural Dexamethasone as an Adjuvant to Local Anaesthesia in Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Randomised Clinical Study

Introduction: Dexamethasone is a potent adjuvant for prolonging analgesia in supraclavicular brachial plexus blocks. However, the optimal route of administration—perineural or intravenous— remains a subject of debate. Aim: To compare the effectiveness and safety of intravenous versus perineural dexamethasone as an adjuvant to local anaesthetics in supraclavicular brachial plexus blocks for upper limb surgeries. Materials and Methods: In this randomised clinical study, conducted in the Department of Anaesthesiology, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India included 80 American Society of Anaesthesiologists (ASA) I and II patients undergoing elective upper limb surgeries were divided into two groups: Group I received intravenous dexamethasone, while Group P received perineural dexamethasone, along with a local anaesthetic mixture. The onset and duration of sensory and motor block, duration of analgesia, haemodynamic changes and complications were assessed. Statistical analysis was performed using the t-test and Chi-square test. Results: Group P exhibited a faster onset of sensory and motor block compared to Group I (p-value <0.05). The duration of sensory block, motor block and postoperative analgesia were significantly longer in Group P (p-value <0.05). Haemodynamic parameters showed significant differences at various time points, but no consistent trend favoured either group. No significant complications were observed. Conclusion: Perineural dexamethasone prolonged the duration of analgesia and sensory and motor block compared to intravenous dexamethasone, without significant side-effects.